Provider Demographics
NPI:1609548353
Name:SIPES, TERRY DELAVAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:DELAVAN
Last Name:SIPES
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 1:8339 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1628
Mailing Address - Country:US
Mailing Address - Phone:248-345-7285
Mailing Address - Fax:
Practice Address - Street 1:20727 WYOMING ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2141
Practice Address - Country:US
Practice Address - Phone:248-566-0116
Practice Address - Fax:248-566-0117
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist