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General NPI Number Information
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NPI Number | 1831295120
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Entity Type | Organization
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Legal Business Name | TIFFANY-DAVIS DRUG CO.
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4310 HIGHWAY 101
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City | FLORENCE
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State | OR
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Zip | 97439-8832
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Country | US
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Telephone | 541-997-3099
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Fax | 541-997-3299
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Provider Business Mailing Address
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Address Line | 960 OAK ST
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City | EUGENE
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State | OR
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Zip | 97401-3106
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Country | US
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Telephone | 541-342-2148
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Fax | 541-686-8305
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DALE B. ENGEL
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Credential | R.PH.
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Telephone | 541-342-2148
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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 | NPA-0007078
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License Number State | OR
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