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General NPI Number Information
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NPI Number | 1104101567
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Entity Type | Individual
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Provider Name | TIFFANY MICHELLE CHAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/18/2011
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Last Update Date | 10/18/2011
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Provider Practice Location Address
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Address Line | 1123 N RALEIGH ST
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City | ROCKY MOUNT
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State | NC
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Zip | 27801-5885
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Country | US
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Telephone | 252-977-0066
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Fax |
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Provider Business Mailing Address
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Address Line | 109 MODENA DR
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City | CARY
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State | NC
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Zip | 27513-1739
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Country | US
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Telephone | 919-349-0895
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 21725
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License Number State | NC
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