Healthcare Provider Details

I. General information

NPI: 1568734358
Provider Name (Legal Business Name): TIFFANIE ANN PYE PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANIE ANN KUNTZ PHARMD

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 11/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N 10TH AVE
STAYTON OR
97383-1311
US

IV. Provider business mailing address

1401 N 10TH AVE
STAYTON OR
97383-1311
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-9223
  • Fax:
Mailing address:
  • Phone: 503-769-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0012683
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number00012683
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: