Provider Demographics
NPI:1619732229
Name:TIPPETT, ANDREA J
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:TIPPETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GREAT VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18706-5324
Mailing Address - Country:US
Mailing Address - Phone:570-820-2919
Mailing Address - Fax:
Practice Address - Street 1:1 GREAT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18706-5324
Practice Address - Country:US
Practice Address - Phone:570-820-2919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039132L1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist