Provider Demographics
NPI:1922417658
Name:GORDON, TIFFANY LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEE
Last Name:GORDON
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 1:501 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6056
Mailing Address - Country:US
Mailing Address - Phone:602-220-6060
Mailing Address - Fax:602-220-6194
Practice Address - Street 1:501 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6056
Practice Address - Country:US
Practice Address - Phone:602-220-6060
Practice Address - Fax:602-220-6194
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0207731835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric