Provider Demographics
NPI:1942419742
Name:TIPPS, JAY MICHAEL (DPH)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:MICHAEL
Last Name:TIPPS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8817 S 70TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5060
Mailing Address - Country:US
Mailing Address - Phone:918-494-3062
Mailing Address - Fax:
Practice Address - Street 1:8817 S 70TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5060
Practice Address - Country:US
Practice Address - Phone:918-494-3062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist