MEDICARE: TIFFANY DICHIARA RPH

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	19233	MD

General Provider Information

NPI Number	:	1649551946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY DICHIARA RPH

Provider Business Mailing Address
First Line	:	6700 RITCHIE HWY
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-2319
Country	:	US
Telephone Number	:	443-848-0245
Fax Number	:	443-848-0248

Provider Business Practice Location Address
First Line	:	6700 RITCHIE HWY
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-2319
Country	:	US
Telephone Number	:	443-848-0245
Fax Number	:	443-848-0248

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

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	08/31/2011

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