Provider Demographics
NPI:1457999419
Name:AN, TIFFANY LILY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:LILY
Last Name:AN
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 1:2240 FAIR PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1910
Mailing Address - Country:US
Mailing Address - Phone:323-254-7346
Mailing Address - Fax:323-254-3760
Practice Address - Street 1:2240 FAIR PARK AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1910
Practice Address - Country:US
Practice Address - Phone:323-254-7346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist