Provider Demographics
NPI:1285183889
Name:CARLISLE, TIFFANY A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:A
Last Name:CARLISLE
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 1:401 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1802
Mailing Address - Country:US
Mailing Address - Phone:207-275-3300
Mailing Address - Fax:207-275-3310
Practice Address - Street 1:401 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1802
Practice Address - Country:US
Practice Address - Phone:207-275-3300
Practice Address - Fax:207-275-3310
Is Sole Proprietor?:No
Enumeration Date:2016-09-25
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPR5208OtherPHARMACIST LICENSE