Healthcare Provider Details

I. General information

NPI: 1801426895
Provider Name (Legal Business Name): TIFFANY MICHELLE BROOKS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2020
Last Update Date: 01/19/2020
Certification Date: 01/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 E NELSON ST
LEXINGTON VA
24450-2729
US

IV. Provider business mailing address

233 MOUNTAIN BROOK DR
ROANOKE VA
24012-6574
US

V. Phone/Fax

Practice location:
  • Phone: 540-464-1180
  • Fax:
Mailing address:
  • Phone: 276-245-6415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202212148
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: