Provider Demographics
NPI:1225780091
Name:WOODWORTH, TIFFANY GAYLE (RPH)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:GAYLE
Last Name:WOODWORTH
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 1:555 WHIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859-2403
Mailing Address - Country:US
Mailing Address - Phone:978-807-3255
Mailing Address - Fax:
Practice Address - Street 1:555 WHIPPLE RD
Practice Address - Street 2:
Practice Address - City:PASCOAG
Practice Address - State:RI
Practice Address - Zip Code:02859-2403
Practice Address - Country:US
Practice Address - Phone:978-807-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238326183500000X
RIRPH-06077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist