Provider Demographics
NPI:1073159455
Name:LAMBERT, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 MAIN HEWETT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAKE
Mailing Address - State:WV
Mailing Address - Zip Code:25121-7129
Mailing Address - Country:US
Mailing Address - Phone:304-752-4492
Mailing Address - Fax:
Practice Address - Street 1:3005 MAIN HEWETT CREEK RD
Practice Address - Street 2:
Practice Address - City:LAKE
Practice Address - State:WV
Practice Address - Zip Code:25121-7129
Practice Address - Country:US
Practice Address - Phone:812-549-3669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV30066464183700000X
WVPT0006592183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician