Provider Demographics
NPI:1013283720
Name:SPRANKLE, KIP LEIGH (RPH)
Entity Type:Individual
Prefix:
First Name:KIP
Middle Name:LEIGH
Last Name:SPRANKLE
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 1:1001 KEYSTONE DR APT B
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8040
Mailing Address - Country:US
Mailing Address - Phone:860-874-2313
Mailing Address - Fax:
Practice Address - Street 1:241 MAIN ST
Practice Address - Street 2:
Practice Address - City:TERRYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06786-5910
Practice Address - Country:US
Practice Address - Phone:860-585-5158
Practice Address - Fax:860-589-8699
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist