MEDICARE: TIFFNEY JACOBSON CPHT

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	VA60654191	WA

General Provider Information

NPI Number	:	1891377370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFNEY JACOBSON CPHT

Provider Business Mailing Address
First Line	:	700 S MAIN ST
Second Line	:
City	:	ELLENSBURG
State	:	WA
Zip	:	98926-3641
Country	:	US
Telephone Number	:	509-925-4232
Fax Number	:	509-925-6063

Provider Business Practice Location Address
First Line	:	700 S MAIN ST
Second Line	:
City	:	ELLENSBURG
State	:	WA
Zip	:	98926-3641
Country	:	US
Telephone Number	:	509-925-4232
Fax Number	:	509-925-6063

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

Provider Enumeration Date	:	04/24/2021
Last Update Date	:	04/24/2021

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