Provider Demographics
NPI:1255032397
Name:STIPE, RANDI MARIA
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:MARIA
Last Name:STIPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W LODI AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3425
Mailing Address - Country:US
Mailing Address - Phone:209-368-5363
Mailing Address - Fax:
Practice Address - Street 1:20051 N DUSTIN RD
Practice Address - Street 2:
Practice Address - City:ACAMPO
Practice Address - State:CA
Practice Address - Zip Code:95220-9758
Practice Address - Country:US
Practice Address - Phone:209-598-9709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124473183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician