MEDICARE: DR. TIFFANY ANDREWS PHARM.D.

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	051297105	IL

General Provider Information

NPI Number	:	1477156149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANY ANDREWS PHARM.D.

Provider Business Mailing Address
First Line	:	410 E 3RD ST S
Second Line	:
City	:	ROYALTON
State	:	IL
Zip	:	62983-1339
Country	:	US
Telephone Number	:	618-751-9723
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 W MAIN ST
Second Line	:
City	:	BENTON
State	:	IL
Zip	:	62812-1329
Country	:	US
Telephone Number	:	618-439-6356
Fax Number	:

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

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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