Provider Demographics
NPI:1265716096
Name:MARTIN, TIFFANY J (PHARM D)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:J
Last Name:MARTIN
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 1:346 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3906
Mailing Address - Country:US
Mailing Address - Phone:870-733-0138
Mailing Address - Fax:870-733-0237
Practice Address - Street 1:346 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3906
Practice Address - Country:US
Practice Address - Phone:870-733-0138
Practice Address - Fax:870-733-0237
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist