Provider Demographics
NPI:1982824843
Name:CLARKE, TIFFANY A (PHARM D)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:CLARKE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9293 REGENTS RD
Mailing Address - Street 2:UNIT 205
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9170
Mailing Address - Country:US
Mailing Address - Phone:858-922-0876
Mailing Address - Fax:
Practice Address - Street 1:9293 REGENTS RD
Practice Address - Street 2:UNIT 205
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-9170
Practice Address - Country:US
Practice Address - Phone:858-922-0876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57841183500000X
MI5302033829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist