Provider Demographics
NPI:1750472569
Name:MOREIRA, TIFFANY N (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:N
Last Name:MOREIRA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 N. MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2308
Mailing Address - Country:US
Mailing Address - Phone:601-364-1555
Mailing Address - Fax:601-364-1548
Practice Address - Street 1:VA MEDICAL CENTER -OUTPATIENT PHARMACY
Practice Address - Street 2:1500 E. WOODROW WILSON DR
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5199
Practice Address - Country:US
Practice Address - Phone:601-364-1557
Practice Address - Fax:601-364-1548
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-08168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist