Provider Demographics
NPI:1689007270
Name:JOHNSON, TIFFANY (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:JOHNSON
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 1:2900 NORTH LOOP W
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-8841
Mailing Address - Country:US
Mailing Address - Phone:832-553-3465
Mailing Address - Fax:
Practice Address - Street 1:2900 NORTH LOOP W
Practice Address - Street 2:SUITE 1300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8841
Practice Address - Country:US
Practice Address - Phone:832-553-3465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist