Provider Demographics
NPI:1487485116
Name:EVANS, TIFFANY (PHARMD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:EVANS
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 1:510 E JEFFERSON ST STE A
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IA
Mailing Address - Zip Code:50060-1812
Mailing Address - Country:US
Mailing Address - Phone:641-872-2030
Mailing Address - Fax:
Practice Address - Street 1:510 E JEFFERSON ST STE A
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060-1812
Practice Address - Country:US
Practice Address - Phone:641-872-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist