1457534950 NPI number — DR. TIFFANEE JANEICE SANDERSON PHARMD

Table of content: DR. TIFFANEE JANEICE SANDERSON PHARMD (NPI 1457534950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457534950 NPI number — DR. TIFFANEE JANEICE SANDERSON PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDERSON
Provider First Name:
TIFFANEE
Provider Middle Name:
JANEICE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LYONS
Provider Other First Name:
TIFFANEE
Provider Other Middle Name:
JANEICE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457534950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07102-1909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-877-2472
Provider Business Mailing Address Fax Number:
973-877-5577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07102-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-877-2472
Provider Business Practice Location Address Fax Number:
973-877-5577
Provider Enumeration Date:
12/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  28RI02970500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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