Provider Demographics
NPI:1760767792
Name:WILLIAMS, TIFFANY A (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:WILLIAMS
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 1:6100 GREENBELT RD
Mailing Address - Street 2:T1295
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4063
Mailing Address - Country:US
Mailing Address - Phone:301-837-0054
Mailing Address - Fax:
Practice Address - Street 1:6100 GREENBELT RD
Practice Address - Street 2:T1295
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-4063
Practice Address - Country:US
Practice Address - Phone:301-837-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist