Provider Demographics
NPI:1275246076
Name:CHOBANIAN, TIFFANY A (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:CHOBANIAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:A
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:295 KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4535
Mailing Address - Country:US
Mailing Address - Phone:207-810-7470
Mailing Address - Fax:207-810-7478
Practice Address - Street 1:295 KENNEDY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4535
Practice Address - Country:US
Practice Address - Phone:207-810-7470
Practice Address - Fax:207-810-7478
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR71051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist