Healthcare Provider Details

I. General information

NPI: 1649760448
Provider Name (Legal Business Name): TIFFANY CONNER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TONGASS DR
SITKA AK
99835-9416
US

IV. Provider business mailing address

106A BARLOW ST
SITKA AK
99835-7616
US

V. Phone/Fax

Practice location:
  • Phone: 907-966-8347
  • Fax: 907-966-8450
Mailing address:
  • Phone: 337-315-2493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0022015
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: