Healthcare Provider Details

I. General information

NPI: 1427781020
Provider Name (Legal Business Name): DR. TIFFANY LYNN HAVERLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 RAMSEY ST
FAYETTEVILLE NC
28311-2138
US

IV. Provider business mailing address

602 E MCNEILL ST
LILLINGTON NC
27546-9189
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-2828
  • Fax: 910-488-8964
Mailing address:
  • Phone: 910-488-2828
  • Fax: 910-488-8964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31282
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: