Provider Demographics
NPI:1831221316
Name:SHIPLEY, GERALD KNOX (RPH)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:KNOX
Last Name:SHIPLEY
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 1:13732 PINE VILLA LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1618
Mailing Address - Country:US
Mailing Address - Phone:239-481-1701
Mailing Address - Fax:239-481-0151
Practice Address - Street 1:9371 CYPRESS LAKE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4939
Practice Address - Country:US
Practice Address - Phone:238-481-7322
Practice Address - Fax:239-481-0151
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH15780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist