Provider Demographics
NPI:1942333869
Name:GOOLSBY, TIFFANY VONETTA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:VONETTA
Last Name:GOOLSBY
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 1:401 EVARTS ST NE
Mailing Address - Street 2:UNIT#204
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-1245
Mailing Address - Country:US
Mailing Address - Phone:202-277-1127
Mailing Address - Fax:
Practice Address - Street 1:401 EVARTS ST NE
Practice Address - Street 2:UNIT#204
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-1245
Practice Address - Country:US
Practice Address - Phone:202-277-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD177371835X0200X
DC183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1835X0200XPharmacy Service ProvidersPharmacistOncology
Not Answered183500000XPharmacy Service ProvidersPharmacist