Provider Demographics
NPI:1760763627
Name:AL-SHAIKH, TIFFANI CONSTANTINO (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:TIFFANI
Middle Name:CONSTANTINO
Last Name:AL-SHAIKH
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 1:10556 COMBIE RD
Mailing Address - Street 2:PMB 6618
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8908
Mailing Address - Country:US
Mailing Address - Phone:650-644-8938
Mailing Address - Fax:530-268-2355
Practice Address - Street 1:10556 COMBIE RD
Practice Address - Street 2:PMB 6618
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8908
Practice Address - Country:US
Practice Address - Phone:650-644-8938
Practice Address - Fax:530-268-2355
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist