Provider Demographics
NPI:1609223320
Name:TWEEDLEY, TINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:TWEEDLEY
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 1:3851 PIPER ST
Mailing Address - Street 2:SUITE U1254
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4684
Mailing Address - Country:US
Mailing Address - Phone:907-212-6880
Mailing Address - Fax:907-212-6877
Practice Address - Street 1:3851 PIPER ST
Practice Address - Street 2:SUITE U1254
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4684
Practice Address - Country:US
Practice Address - Phone:907-212-6880
Practice Address - Fax:907-212-6877
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1919183500000X
WAPH 60093633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist