Provider Demographics
NPI:1679447981
Name:STEPHENS, TIFFANY WELBORN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:WELBORN
Last Name:STEPHENS
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 1:640 SUMMIT CROSSING PL STE 204
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2142
Mailing Address - Country:US
Mailing Address - Phone:704-865-0626
Mailing Address - Fax:704-865-6531
Practice Address - Street 1:640 SUMMIT CROSSING PL STE 204
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2142
Practice Address - Country:US
Practice Address - Phone:704-865-0626
Practice Address - Fax:704-865-6531
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty