Provider Demographics
NPI:1306128772
Name:HUDDLESTON, TIFFANY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1132
Mailing Address - Country:US
Mailing Address - Phone:800-727-5514
Mailing Address - Fax:800-727-5518
Practice Address - Street 1:301 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1132
Practice Address - Country:US
Practice Address - Phone:800-727-5514
Practice Address - Fax:800-727-5518
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist