Provider Demographics
NPI:1356626915
Name:PORTER, TIFFANY MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:MARIE
Last Name:PORTER
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 1:1728 HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2118
Mailing Address - Country:US
Mailing Address - Phone:205-980-0489
Mailing Address - Fax:
Practice Address - Street 1:1728 HIGHWAY 45 N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2118
Practice Address - Country:US
Practice Address - Phone:662-328-0747
Practice Address - Fax:662-328-4081
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-11994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist