Provider Demographics
NPI:1093972879
Name:OAKLAND, TIFFANY JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JEAN
Last Name:OAKLAND
Suffix:
Gender:F
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:PO BOX 2427
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-2427
Mailing Address - Country:US
Mailing Address - Phone:208-634-5793
Mailing Address - Fax:
Practice Address - Street 1:451 DEINHARD LN
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-4800
Practice Address - Country:US
Practice Address - Phone:208-634-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist