Provider Demographics
NPI:1215221585
Name:REASLAND, TIFFANY TARR (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:TARR
Last Name:REASLAND
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 1:12500 K PLZ
Mailing Address - Street 2:T2383
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2207
Mailing Address - Country:US
Mailing Address - Phone:402-334-3436
Mailing Address - Fax:402-334-3436
Practice Address - Street 1:12500 K PLZ
Practice Address - Street 2:T2383
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2207
Practice Address - Country:US
Practice Address - Phone:402-334-3436
Practice Address - Fax:402-334-3436
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist