Provider Demographics
NPI:1578658704
Name:EFFIONG, TIANN CAMPBELL (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:TIANN
Middle Name:CAMPBELL
Last Name:EFFIONG
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:TIANN
Other - Middle Name:TAMEKA
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1623 FLATBUSH AVE
Mailing Address - Street 2:LOCATED WITHIN CATHOLIC CHARITIES OF BROOKLYN & QUEENS
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3262
Mailing Address - Country:US
Mailing Address - Phone:347-410-7686
Mailing Address - Fax:347-269-1128
Practice Address - Street 1:1623 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3262
Practice Address - Country:US
Practice Address - Phone:347-410-7686
Practice Address - Fax:347-269-1128
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0039892183500000X
NYI063847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY584305OtherGENOA HEALTHCARE - SITE 20421 NCPDP
FL1002031OtherNABP
FL1002031OtherNABP
FL0556050968Medicare ID - Type Unspecified