Healthcare Provider Details

I. General information

NPI: 1497188494
Provider Name (Legal Business Name): TIFFANY DIEMER PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 01/05/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 MCCAIN BLVD
NORTH LITTLE ROCK AR
72116-7606
US

IV. Provider business mailing address

2509 MCCAIN BLVD
NORTH LITTLE ROCK AR
72116-7606
US

V. Phone/Fax

Practice location:
  • Phone: 501-837-1227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPD12365
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: