Provider Demographics
NPI:1588855704
Name:TIPTON, ROY ALLEN (RPH)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:ALLEN
Last Name:TIPTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:COPPERHILL
Mailing Address - State:TN
Mailing Address - Zip Code:37317-0370
Mailing Address - Country:US
Mailing Address - Phone:423-496-5241
Mailing Address - Fax:423-496-5240
Practice Address - Street 1:116 W OCOEE ST
Practice Address - Street 2:
Practice Address - City:COPPERHILL
Practice Address - State:TN
Practice Address - Zip Code:37317-0370
Practice Address - Country:US
Practice Address - Phone:423-496-5241
Practice Address - Fax:423-496-5240
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist