Provider Demographics
NPI:1669074993
Name:CROWELL, TIFFANY MARY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:MARY
Last Name:CROWELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:WINGENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 W POLK ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-3297
Mailing Address - Country:US
Mailing Address - Phone:660-438-2207
Mailing Address - Fax:660-438-4304
Practice Address - Street 1:103 W POLK ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3297
Practice Address - Country:US
Practice Address - Phone:660-438-2207
Practice Address - Fax:660-438-4304
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170226101835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist