Healthcare Provider Details

I. General information

NPI: 1356239321
Provider Name (Legal Business Name): TIFFANY BUCKLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WADE AVE BLDG ROOM108
CATONSVILLE MD
21228-4663
US

IV. Provider business mailing address

55 WADE AVE BLDG ROOM108
CATONSVILLE MD
21228-4663
US

V. Phone/Fax

Practice location:
  • Phone: 757-377-7368
  • Fax:
Mailing address:
  • Phone: 757-377-7368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number76846
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number76846
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number25763
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: