Healthcare Provider Details

I. General information

NPI: 1114261336
Provider Name (Legal Business Name): TIFFANY KUWATANI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 MAIN STREET
WATSONVILLE CA
95076
US

IV. Provider business mailing address

1415 MAIN ST
WATSONVILLE CA
95076-3755
US

V. Phone/Fax

Practice location:
  • Phone: 831-740-4283
  • Fax:
Mailing address:
  • Phone: 831-740-4283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number68244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: