Provider Demographics
NPI:1164703237
Name:LIESMANN, TIFFANY (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:LIESMANN
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 1:2901 SE CALIFORNIA AVE
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-2466
Mailing Address - Country:US
Mailing Address - Phone:785-266-9470
Mailing Address - Fax:
Practice Address - Street 1:2901 SE CALIFORNIA AVE
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-2466
Practice Address - Country:US
Practice Address - Phone:785-266-9470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist