Provider Demographics
NPI:1720373608
Name:RIPPLE, ANISSA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANISSA
Middle Name:MARIE
Last Name:RIPPLE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23555 ALLEN RD
Mailing Address - Street 2:T-0923
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-3381
Mailing Address - Country:US
Mailing Address - Phone:734-672-0005
Mailing Address - Fax:734-672-0005
Practice Address - Street 1:23555 ALLEN RD
Practice Address - Street 2:T-0923
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-3381
Practice Address - Country:US
Practice Address - Phone:734-672-0005
Practice Address - Fax:734-672-0005
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist