Provider Demographics
NPI:1790190874
Name:COLLINS, TIFFANY ROCHELLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:ROCHELLE
Last Name:COLLINS
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 1:104 LEGACY DR
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-9594
Mailing Address - Country:US
Mailing Address - Phone:859-986-2323
Mailing Address - Fax:859-985-1035
Practice Address - Street 1:104 LEGACY DR
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-9594
Practice Address - Country:US
Practice Address - Phone:859-986-2323
Practice Address - Fax:859-985-1035
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist