Provider Demographics
NPI:1013298322
Name:VANIPEREN, RICK L (RPH , MBA)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:L
Last Name:VANIPEREN
Suffix:
Gender:M
Credentials:RPH , MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W232N7677 HABITAT CT
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-1562
Mailing Address - Country:US
Mailing Address - Phone:414-617-1634
Mailing Address - Fax:
Practice Address - Street 1:W232N7677 HABITAT CT
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-1562
Practice Address - Country:US
Practice Address - Phone:414-617-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14326183500000X
WI132171835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist