Healthcare Provider Details

I. General information

NPI: 1578074886
Provider Name (Legal Business Name): MS. TIFFANY TASHIREA ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2017
Last Update Date: 10/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 SANGER RD RM 180
ORLANDO FL
32827-7445
US

IV. Provider business mailing address

6550 SANGER RD RM 180
ORLANDO FL
32827-7445
US

V. Phone/Fax

Practice location:
  • Phone: 407-313-7025
  • Fax: 407-313-7056
Mailing address:
  • Phone: 407-313-7025
  • Fax: 407-313-7056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS49653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: