Healthcare Provider Details

I. General information

NPI: 1477563211
Provider Name (Legal Business Name): TIFFANY C RODGERS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

7500 NW 130TH ST
OKLAHOMA CITY OK
73142-2569
US

V. Phone/Fax

Practice location:
  • Phone: 405-270-0501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number39964
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: