MEDICARE: TIFFANY WEISS PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26676	TN
2	183500000X	Pharmacist	PS47545	FL

General Provider Information

NPI Number	:	1053914929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY WEISS PHARMD

Provider Business Mailing Address
First Line	:	5202 MANN MANOR LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6331 ROOSEVELT BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-3303
Country	:	US
Telephone Number	:	904-596-1066
Fax Number	:	904-520-4184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	11/20/2020

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Directions to “ TIFFANY WEISS PHARMD” Practice Location

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