Provider Demographics
NPI:1942850136
Name:SIPPER, DANETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:
Last Name:SIPPER
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 1:200 DEER CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-2116
Mailing Address - Country:US
Mailing Address - Phone:678-477-2008
Mailing Address - Fax:
Practice Address - Street 1:1000 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-2204
Practice Address - Country:US
Practice Address - Phone:706-376-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist