Provider Demographics
NPI:1760107296
Name:HAWKRIDGE, TIFFANY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:HAWKRIDGE
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 1:1400 BABCOCK BLVD E
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-2811
Mailing Address - Country:US
Mailing Address - Phone:763-972-8385
Mailing Address - Fax:763-972-8391
Practice Address - Street 1:1400 BABCOCK BLVD E
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-2811
Practice Address - Country:US
Practice Address - Phone:763-972-8385
Practice Address - Fax:763-972-8391
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty