Provider Demographics
NPI:1093855058
Name:TIFFANY NATURAL PHARMACY INC
Entity Type:Organization
Organization Name:TIFFANY NATURAL PHARMACY INC
Other - Org Name:TIFFANY NATURAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PINTO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:908-233-2200
Mailing Address - Street 1:1115 SOUTH AVE W
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1418
Mailing Address - Country:US
Mailing Address - Phone:908-233-2200
Mailing Address - Fax:908-233-3975
Practice Address - Street 1:1115 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1418
Practice Address - Country:US
Practice Address - Phone:908-233-2200
Practice Address - Fax:908-233-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00575300332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
28RS00575300OtherNJ BOARD OF PHARMACY STATE PERMIT
NJ8059811OtherMEDICAID DME
NJ3141479OtherNABP#
NJ8059802Medicaid