Healthcare Provider Details

I. General information

NPI: 1679447981
Provider Name (Legal Business Name): TIFFANY WELBORN STEPHENS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 SUMMIT CROSSING PL STE 204
GASTONIA NC
28054-2142
US

IV. Provider business mailing address

640 SUMMIT CROSSING PL STE 204
GASTONIA NC
28054-2142
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-0626
  • Fax: 704-865-6531
Mailing address:
  • Phone: 704-865-0626
  • Fax: 704-865-6531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33782
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: