Provider Demographics
NPI:1770821126
Name:KIPP, ROBERT A (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:KIPP
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 1:949 ALLEGRO LN
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2775
Mailing Address - Country:US
Mailing Address - Phone:813-215-3668
Mailing Address - Fax:
Practice Address - Street 1:13154 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7410
Practice Address - Country:US
Practice Address - Phone:813-741-0592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS17576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist