Provider Demographics
NPI:1548031792
Name:SOMEREVILLE, TIFFANY (PHARMD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:SOMEREVILLE
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 1:609 N WESTOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2188
Mailing Address - Country:US
Mailing Address - Phone:561-313-2147
Mailing Address - Fax:
Practice Address - Street 1:609 N WESTOVER BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2188
Practice Address - Country:US
Practice Address - Phone:229-439-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist