Provider Demographics
NPI:1700049483
Name:EVANS, TIFFANY GRACE (PHARM D)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:GRACE
Last Name:EVANS
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 1:2024 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2680
Mailing Address - Country:US
Mailing Address - Phone:315-361-1184
Mailing Address - Fax:315-361-1197
Practice Address - Street 1:2024 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2680
Practice Address - Country:US
Practice Address - Phone:315-361-1184
Practice Address - Fax:315-361-1197
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052341 1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist