Provider Demographics
NPI:1770361909
Name:ROBERTS, TIFFANY MORRIS (PHARMD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MORRIS
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:DIANE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 ROLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-4327
Mailing Address - Country:US
Mailing Address - Phone:731-423-2273
Mailing Address - Fax:
Practice Address - Street 1:505 ROLAND AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-4301
Practice Address - Country:US
Practice Address - Phone:731-423-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist