Provider Demographics
NPI:1629660360
Name:GUTIERREZ, TIFFANY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:GUTIERREZ
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 1:25830 N 40TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-9015
Mailing Address - Country:US
Mailing Address - Phone:602-291-3130
Mailing Address - Fax:
Practice Address - Street 1:28635 N NORTH VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-5434
Practice Address - Country:US
Practice Address - Phone:623-582-9207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist