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General NPI Number Information
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NPI Number | 1114730462
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Entity Type | Individual
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Provider Name | TIFFANY ELLIS
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Gender | Female
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 15700 N US HIGHWAY 169
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City | SMITHVILLE
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State | MO
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Zip | 64089-9314
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Country | US
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Telephone | 816-532-6140
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Fax |
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Provider Business Mailing Address
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Address Line | 14906 KELLY DR
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City | SMITHVILLE
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State | MO
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Zip | 64089-8405
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Country | US
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Telephone | 518-810-2941
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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 | 2020027251
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License Number State | MO
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