Provider Demographics
NPI:1912449265
Name:HUNTER, TIFFANY (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:HUNTER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 AVONDALE DR APT 202
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-6005
Mailing Address - Country:US
Mailing Address - Phone:304-925-7438
Mailing Address - Fax:304-926-6591
Practice Address - Street 1:3805 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1527
Practice Address - Country:US
Practice Address - Phone:304-925-7438
Practice Address - Fax:304-926-6591
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0009934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist