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General NPI Number Information
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NPI Number | 1437529682
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Entity Type | Individual
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Provider Name | TIFFANY BRACAMONTE
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Gender | Female
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 2900 W ANDERSON LN
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City | AUSTIN
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State | TX
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Zip | 78757-1102
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Country | US
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Telephone | 210-410-0199
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Fax |
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Provider Business Mailing Address
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Address Line | 902 ALAMO PLAZA DR
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City | CEDAR PARK
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State | TX
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Zip | 78613-7809
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Country | US
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Telephone | 210-410-0199
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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 | S019591
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License Number State | AZ
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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 | 48863
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License Number State | TX
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