Provider Demographics
NPI:1194320929
Name:PRIMM, TIFFANY CHERESE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:CHERESE
Last Name:PRIMM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 DANBURY LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1458
Mailing Address - Country:US
Mailing Address - Phone:216-469-4526
Mailing Address - Fax:
Practice Address - Street 1:4519 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4016
Practice Address - Country:US
Practice Address - Phone:216-691-8990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03331484333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy