Healthcare Provider Details

I. General information

NPI: 1255268397
Provider Name (Legal Business Name): TIFFANY RAINWATER R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 S 1100 E STE 104
SALT LAKE CITY UT
84102-1687
US

IV. Provider business mailing address

82 S 1100 E STE 104
SALT LAKE CITY UT
84102-1687
US

V. Phone/Fax

Practice location:
  • Phone: 801-521-6353
  • Fax:
Mailing address:
  • Phone: 801-521-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number338977-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: