Provider Demographics
NPI:1801477898
Name:STIFF, TRINA SUE (CPHT)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:SUE
Last Name:STIFF
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21353 35TH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1766
Mailing Address - Country:US
Mailing Address - Phone:718-306-4559
Mailing Address - Fax:
Practice Address - Street 1:3920 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2061
Practice Address - Country:US
Practice Address - Phone:718-224-2606
Practice Address - Fax:718-224-8083
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30138009183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician