Provider Demographics
NPI:1922620772
Name:LYON, TIFFANY GARNER (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:GARNER
Last Name:LYON
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 1:7968 CRESCENT MOON PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1069
Mailing Address - Country:US
Mailing Address - Phone:915-227-7637
Mailing Address - Fax:
Practice Address - Street 1:2701 N MESA ST STE 100A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2543
Practice Address - Country:US
Practice Address - Phone:915-444-3423
Practice Address - Fax:915-444-3424
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009270183500000X
TX63533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist