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NPI Code Detail

MEDICARE: TIFFANY CHAN

MEDICARE: TIFFANY CHAN
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
1183500000XPharmacist20293NV

General Provider Information

NPI Number : 1114522323
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY CHAN
Provider Business Mailing Address
First Line : 8320 W CHEYENNE AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-2147
Country : US
Telephone Number : 702-658-1229
Fax Number :
Provider Business Practice Location Address
First Line : 8320 W CHEYENNE AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-2147
Country : US
Telephone Number : 702-658-1229
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2020
Last Update Date : 12/03/2020

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Directions to “ TIFFANY CHAN ” Practice Location

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