Provider Demographics
NPI:1194008193
Name:BIRD, TIFFANY ROBIN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:ROBIN
Last Name:BIRD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 PASS RD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2111
Mailing Address - Country:US
Mailing Address - Phone:228-388-3458
Mailing Address - Fax:228-388-4091
Practice Address - Street 1:2405 PASS RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2111
Practice Address - Country:US
Practice Address - Phone:228-388-3458
Practice Address - Fax:228-388-4091
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS010801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist