Provider Demographics
NPI:1528358587
Name:STADLER, TIFFANY
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:STADLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 W ARROWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-7939
Mailing Address - Country:US
Mailing Address - Phone:704-525-2628
Mailing Address - Fax:
Practice Address - Street 1:2215 W ARROWOOD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-7939
Practice Address - Country:US
Practice Address - Phone:704-525-2628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist