Provider Demographics
NPI:1649551946
Name:DICHIARA, TIFFANY (RPH)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:DICHIARA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6700 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2319
Mailing Address - Country:US
Mailing Address - Phone:443-848-0245
Mailing Address - Fax:443-848-0248
Practice Address - Street 1:6700 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2319
Practice Address - Country:US
Practice Address - Phone:443-848-0245
Practice Address - Fax:443-848-0248
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist