MEDICARE: TIFFANY A BUCKLEY CPHT, CPB

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	183700000X	Pharmacy Technician	T2081	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	T-2081	OTHER	OK	OK BOARD OF PHARMACY

General Provider Information

NPI Number	:	1619068426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY A BUCKLEY CPHT, CPB

Provider Business Mailing Address
First Line	:	4734 S 252ND WEST AVE
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-4319
Country	:	US
Telephone Number	:	580-761-5034
Fax Number	:

Provider Business Practice Location Address
First Line	:	4734 S 252ND WEST AVE
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-4319
Country	:	US
Telephone Number	:	580-761-5034
Fax Number	:

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	04/28/2016

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