Provider Demographics
NPI:1497817357
Name:IPPOLITO, VINCENT (RPH)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:IPPOLITO
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 1:2456 PIMLICO CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2009
Mailing Address - Country:US
Mailing Address - Phone:301-843-9804
Mailing Address - Fax:301-932-9373
Practice Address - Street 1:3973 SAINT CHARLES PKWY
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2683
Practice Address - Country:US
Practice Address - Phone:301-932-7977
Practice Address - Fax:301-932-9373
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist