Provider Demographics
NPI:1932719630
Name:TIPTON, PAYTON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAYTON
Middle Name:
Last Name:TIPTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL PARK BLVD STE 200E
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7498
Mailing Address - Country:US
Mailing Address - Phone:423-844-5100
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PARK BLVD STE 200E
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7498
Practice Address - Country:US
Practice Address - Phone:423-844-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29771183500000X
TN442911835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist