Provider Demographics
NPI:1174778013
Name:SIPPLE, STACY LEIGH (RPH, CPH)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LEIGH
Last Name:SIPPLE
Suffix:
Gender:F
Credentials:RPH, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 W ROYAL PALM RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-4415
Mailing Address - Country:US
Mailing Address - Phone:561-347-1433
Mailing Address - Fax:
Practice Address - Street 1:1239 W ROYAL PALM RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-4415
Practice Address - Country:US
Practice Address - Phone:561-347-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34013183500000X
FLPU5708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist