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General NPI Number Information
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NPI Number | 1245832872
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Entity Type | Individual
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Provider Name | TIFFANY MEDLOCK
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Gender | Female
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 1515 HIGHWAY 278 E
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City | AMORY
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State | MS
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Zip | 38821-5909
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Country | US
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Telephone | 662-256-1590
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Fax |
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Provider Business Mailing Address
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Address Line | 200 SAWGRASS RD
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City | STARKVILLE
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State | MS
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Zip | 39759-7696
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Country | US
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Telephone | 912-414-0736
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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 | RPH028123
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS59609
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | T-15890
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License Number State | MS
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