Provider Demographics
NPI:1245855642
Name:ATHON, TIFFANY ANNA (PHARM D)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANNA
Last Name:ATHON
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 1:500 N BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-3214
Mailing Address - Country:US
Mailing Address - Phone:660-349-9416
Mailing Address - Fax:
Practice Address - Street 1:HY-VEE PHARMACY
Practice Address - Street 2:500 N BALTIMORE
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501
Practice Address - Country:US
Practice Address - Phone:660-665-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080181771835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care