Provider Demographics
NPI:1083150775
Name:EMERSON, TIFFANI THERESA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANI
Middle Name:THERESA
Last Name:EMERSON
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 1:1830 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-1449
Mailing Address - Country:US
Mailing Address - Phone:805-348-3555
Mailing Address - Fax:805-348-3563
Practice Address - Street 1:1830 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-1449
Practice Address - Country:US
Practice Address - Phone:805-348-3555
Practice Address - Fax:805-348-3563
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH69454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist