Healthcare Provider Details

I. General information

NPI: 1295455343
Provider Name (Legal Business Name): TIFFANY TU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17801 108TH AVE SE
RENTON WA
98055-6423
US

IV. Provider business mailing address

17801 108TH AVE SE
RENTON WA
98055-6423
US

V. Phone/Fax

Practice location:
  • Phone: 425-235-5383
  • Fax:
Mailing address:
  • Phone: 425-235-5383
  • Fax: 425-235-5392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2022033840
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH6162646
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: