Healthcare Provider Details

I. General information

NPI: 1912961285
Provider Name (Legal Business Name): TIFFANY MARIE GRUEBER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CLERMONT ST PHARMACY (119)
DENVER CO
80220-3808
US

IV. Provider business mailing address

1055 CLERMONT ST. PHARMACY (119)
DENVER CO
80220
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-8020
  • Fax:
Mailing address:
  • Phone: 303-399-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12038
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number12038
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: