Provider Demographics
NPI:1780142257
Name:TIWANA, ANUM
Entity type:Individual
Prefix:
First Name:ANUM
Middle Name:
Last Name:TIWANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 CULVER RD APT 2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2369
Mailing Address - Country:US
Mailing Address - Phone:315-728-8495
Mailing Address - Fax:
Practice Address - Street 1:1433 CULVER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-4235
Practice Address - Country:US
Practice Address - Phone:585-288-3000
Practice Address - Fax:585-288-7323
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist