Provider Demographics
NPI:1306461181
Name:MEDINGER, TIFFANY R (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:R
Last Name:MEDINGER
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 1:313 TURTLE DOVE LN NE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-1452
Mailing Address - Country:US
Mailing Address - Phone:319-400-0575
Mailing Address - Fax:
Practice Address - Street 1:103 E CARLISLE
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2004
Practice Address - Country:US
Practice Address - Phone:563-652-6733
Practice Address - Fax:563-652-6050
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist