Provider Demographics
NPI:1851425839
Name:FIEBELKORN, TINA LI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:LI
Last Name:FIEBELKORN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:33 DEER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1292
Mailing Address - Country:US
Mailing Address - Phone:716-636-3022
Mailing Address - Fax:716-636-3022
Practice Address - Street 1:33 DEER RIDGE CT
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1292
Practice Address - Country:US
Practice Address - Phone:716-636-3022
Practice Address - Fax:716-636-3022
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325991835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric