Provider Demographics
NPI:1275090516
Name:AU, TIFFANY JANE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:JANE
Last Name:AU
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MARBLEHEAD DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-2111
Mailing Address - Country:US
Mailing Address - Phone:609-721-2811
Mailing Address - Fax:
Practice Address - Street 1:521 S BROAD ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-1819
Practice Address - Country:US
Practice Address - Phone:609-858-7560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03980300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03980300OtherPHARMACIST LICENSE