Provider Demographics
NPI:1568062289
Name:ROBISON, TIFFANI RAE (RPH)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:RAE
Last Name:ROBISON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4689 W CEDAR HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8093
Mailing Address - Country:US
Mailing Address - Phone:801-756-5210
Mailing Address - Fax:
Practice Address - Street 1:4689 W CEDAR HILLS DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILLS
Practice Address - State:UT
Practice Address - Zip Code:84062-8093
Practice Address - Country:US
Practice Address - Phone:801-756-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT337907-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist