Provider Demographics
NPI:1124566153
Name:ROSS, TIFFANY (RPH)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:ROSS
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 1:301 NORTHWYND CIR
Mailing Address - Street 2:APT 203
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-3448
Mailing Address - Country:US
Mailing Address - Phone:740-464-6818
Mailing Address - Fax:
Practice Address - Street 1:7789 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:APPOMATTOX
Practice Address - State:VA
Practice Address - Zip Code:24522-8680
Practice Address - Country:US
Practice Address - Phone:434-352-0817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202214244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist