Provider Demographics
NPI:1528403284
Name:DIPAOLA, TIFFANY (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:DIPAOLA
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 1:1150 SEABOARD ST
Mailing Address - Street 2:T-0963
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-6517
Mailing Address - Country:US
Mailing Address - Phone:843-626-5034
Mailing Address - Fax:
Practice Address - Street 1:1150 SEABOARD ST
Practice Address - Street 2:T-0963
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-6517
Practice Address - Country:US
Practice Address - Phone:843-626-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist