Provider Demographics
NPI:1255168605
Name:ZAGABE, PIPPEN VALERY
Entity type:Individual
Prefix:
First Name:PIPPEN
Middle Name:VALERY
Last Name:ZAGABE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-3070
Mailing Address - Country:US
Mailing Address - Phone:131-545-2608
Mailing Address - Fax:
Practice Address - Street 1:2329 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-3070
Practice Address - Country:US
Practice Address - Phone:131-545-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist