Provider Demographics
NPI:1053690081
Name:BROCKMAN, TIFFANY MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MARIE
Last Name:BROCKMAN
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 1:255 ROUTE 220 HWY
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-7568
Mailing Address - Country:US
Mailing Address - Phone:570-271-5594
Mailing Address - Fax:570-271-5595
Practice Address - Street 1:255 US HIGHWAY 220
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-6561
Practice Address - Country:US
Practice Address - Phone:570-271-5594
Practice Address - Fax:570-271-5595
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445829183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist