Healthcare Provider Details

I. General information

NPI: 1285579490
Provider Name (Legal Business Name): TIFFANY ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3852 MAIN ST
STONE RIDGE NY
12484-5611
US

IV. Provider business mailing address

500 WASHINGTON AVE APT 7H
KINGSTON NY
12401-2918
US

V. Phone/Fax

Practice location:
  • Phone: 845-687-7766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073584
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: