Provider Demographics
NPI:1710194006
Name:SHIPP, GARRY STEPHEN (RPH)
Entity type:Individual
Prefix:MR
First Name:GARRY
Middle Name:STEPHEN
Last Name:SHIPP
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 1:235 COUNTY ROAD 489
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37331-5496
Mailing Address - Country:US
Mailing Address - Phone:423-263-4276
Mailing Address - Fax:
Practice Address - Street 1:856 HIGHWAY 411 N
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:TN
Practice Address - Zip Code:37331-1912
Practice Address - Country:US
Practice Address - Phone:423-263-5656
Practice Address - Fax:423-263-1803
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10499183500000X
GA10889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist