Healthcare Provider Details

I. General information

NPI: 1568243699
Provider Name (Legal Business Name): TIFFANY HUYNH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 GARDEN CITY DR
HYATTSVILLE MD
20785-2418
US

IV. Provider business mailing address

4105 WATKINS TRL
ANNANDALE VA
22003-2051
US

V. Phone/Fax

Practice location:
  • Phone: 800-777-7904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29461
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202221634
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: