Provider Demographics
NPI:1790082097
Name:LEE, TIFFANY ANN DRAKE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:ANN DRAKE
Last Name:LEE
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 1:618 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-6707
Mailing Address - Country:US
Mailing Address - Phone:864-962-1839
Mailing Address - Fax:864-962-1805
Practice Address - Street 1:618 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6707
Practice Address - Country:US
Practice Address - Phone:864-962-1839
Practice Address - Fax:864-962-1805
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist