Healthcare Provider Details

I. General information

NPI: 1669074993
Provider Name (Legal Business Name): TIFFANY MARY CROWELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. TIFFANY WINGENDER

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W POLK ST
WARSAW MO
65355-3297
US

IV. Provider business mailing address

103 W POLK ST
WARSAW MO
65355-3297
US

V. Phone/Fax

Practice location:
  • Phone: 660-438-2207
  • Fax: 660-438-4304
Mailing address:
  • Phone: 660-438-2207
  • Fax: 660-438-4304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number2017022610
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: