Provider Demographics
NPI:1124208467
Name:HABER, TIFFANY LAUREN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LAUREN
Last Name:HABER
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 1:12 W 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1635
Mailing Address - Country:US
Mailing Address - Phone:315-598-1018
Mailing Address - Fax:315-598-2475
Practice Address - Street 1:12 W 1ST ST S
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1635
Practice Address - Country:US
Practice Address - Phone:315-598-1018
Practice Address - Fax:315-598-2475
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-03
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046218-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist