MEDICARE: TIFFANY WILSON 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	17590	AL

General Provider Information

NPI Number	:	1497342398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY WILSON PHARMD

Provider Business Mailing Address
First Line	:	1604 CHESWOOD CIR
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-5403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4736 EASTERN VALLEY RD
Second Line	:
City	:	MC CALLA
State	:	AL
Zip	:	35111-3406
Country	:	US
Telephone Number	:	205-477-8049
Fax Number	:

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

Provider Enumeration Date	:	12/25/2020
Last Update Date	:	12/25/2020

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Directions to “ TIFFANY WILSON PHARMD” Practice Location

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