Provider Demographics
NPI:1891081147
Name:DAVIS, TIFFANY (PHARMD, BA)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHARMD, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W ARBROOK BLVD
Mailing Address - Street 2:T-1339
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4107
Mailing Address - Country:US
Mailing Address - Phone:817-557-9560
Mailing Address - Fax:
Practice Address - Street 1:1600 W ARBROOK BLVD
Practice Address - Street 2:T-1339
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4107
Practice Address - Country:US
Practice Address - Phone:817-557-9560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist