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NPI Code Detail

MEDICARE: TIFFANI FAGAN PHARMD

MEDICARE: TIFFANI FAGAN 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
1183500000XPharmacistPS55273FL

General Provider Information

NPI Number : 1225582513
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANI FAGAN PHARMD
Provider Business Mailing Address
First Line : 3914 W COMMERCIAL BLVD
Second Line :
City : TAMARAC
State : FL
Zip : 33309-3318
Country : US
Telephone Number : 954-485-6796
Fax Number :
Provider Business Practice Location Address
First Line : 3914 W COMMERCIAL BLVD
Second Line :
City : TAMARAC
State : FL
Zip : 33309-3318
Country : US
Telephone Number : 954-485-6796
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2016
Last Update Date : 08/04/2016

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Directions to “ TIFFANI FAGAN PHARMD” Practice Location

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