Provider Demographics
NPI:1356913800
Name:KHACHIKYAN, TIFFANY TEVOLINA (PHARMD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:TEVOLINA
Last Name:KHACHIKYAN
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 1:1431 OZARK RDG
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1079
Mailing Address - Country:US
Mailing Address - Phone:818-397-3177
Mailing Address - Fax:
Practice Address - Street 1:113 1ST STREET W
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314
Practice Address - Country:US
Practice Address - Phone:318-895-6248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist