Healthcare Provider Details

I. General information

NPI: 1861143430
Provider Name (Legal Business Name): TIFFANY DANIELLE KLIEWER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MILL ST
RENO NV
89502-1576
US

IV. Provider business mailing address

6632 BRECKENRIDGE CT
RENO NV
89523-1296
US

V. Phone/Fax

Practice location:
  • Phone: 775-466-1267
  • Fax:
Mailing address:
  • Phone: 775-224-2575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number18687
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: