Healthcare Provider Details

I. General information

NPI: 1871071530
Provider Name (Legal Business Name): TIFFANY DAWN HURST D.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 KITTRELL ST
HOHENWALD TN
38462-1363
US

IV. Provider business mailing address

110 KITTRELL ST
HOHENWALD TN
38462-1363
US

V. Phone/Fax

Practice location:
  • Phone: 931-295-3406
  • Fax: 931-295-3408
Mailing address:
  • Phone: 931-295-3406
  • Fax: 931-295-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9200
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: