Healthcare Provider Details

I. General information

NPI: 1487807269
Provider Name (Legal Business Name): TIFFANY MARIE REINITZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 VALLEYGREEN SQUARE
LESUEUR MN
56058
US

IV. Provider business mailing address

204 VALLEY GREEN SQ
LE SUEUR MN
56058-1915
US

V. Phone/Fax

Practice location:
  • Phone: 507-665-3301
  • Fax:
Mailing address:
  • Phone: 507-665-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number118568
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: