Provider Demographics
NPI:1043857394
Name:DANIEL, TIFFANY (PHARM D)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 E HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-6823
Mailing Address - Country:US
Mailing Address - Phone:870-534-1380
Mailing Address - Fax:866-572-0139
Practice Address - Street 1:1605 E HARDING AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-6823
Practice Address - Country:US
Practice Address - Phone:870-534-1380
Practice Address - Fax:866-572-0139
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist