Provider Demographics
NPI:1639535701
Name:TOM, TIFFANY (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:TOM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12381 CREEKVIEW DR
Mailing Address - Street 2:UNIT 117
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-6641
Mailing Address - Country:US
Mailing Address - Phone:323-313-2268
Mailing Address - Fax:
Practice Address - Street 1:2255 S EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6318
Practice Address - Country:US
Practice Address - Phone:760-828-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist