Provider Demographics
NPI:1922615467
Name:CARDWELL, TIFFANY BRADBERRY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:BRADBERRY
Last Name:CARDWELL
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 1:1016 S SHORES RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8754
Mailing Address - Country:US
Mailing Address - Phone:904-415-5506
Mailing Address - Fax:
Practice Address - Street 1:9518 ARGYLE FOREST BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-2800
Practice Address - Country:US
Practice Address - Phone:904-317-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist