Provider Demographics
NPI:1326392903
Name:RICHARD, TIFFANY L (RPH)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:RICHARD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 SPANISH PASS RD
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-7935
Mailing Address - Country:US
Mailing Address - Phone:337-288-7687
Mailing Address - Fax:
Practice Address - Street 1:1210 HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:ARNAUDVILLE
Practice Address - State:LA
Practice Address - Zip Code:70512-5404
Practice Address - Country:US
Practice Address - Phone:337-288-7687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-03
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15766183500000X
TX51373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist