Provider Demographics
NPI:1457534950
Name:SANDERSON, TIFFANEE JANEICE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANEE
Middle Name:JANEICE
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TIFFANEE
Other - Middle Name:JANEICE
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:111 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1909
Mailing Address - Country:US
Mailing Address - Phone:973-877-2472
Mailing Address - Fax:973-877-5577
Practice Address - Street 1:111 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1909
Practice Address - Country:US
Practice Address - Phone:973-877-2472
Practice Address - Fax:973-877-5577
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02970500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist