1518099076 NPI number — MRS. TIFFANY ANN MOORE PHARM.D.

Table of content: MAKENNA DIEM-CONLEN (NPI 1740072743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518099076 NPI number — MRS. TIFFANY ANN MOORE PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
TIFFANY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518099076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6339 W ROXBURY PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80128-4675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-954-8932
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13111 W ALAMEDA PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80228-3108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-980-0283
Provider Business Practice Location Address Fax Number:
303-980-0923
Provider Enumeration Date:
03/11/2007

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:  PH00065407 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 17643 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 3149 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 17643 . This is a "PHARMACIST" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 3149 . This is a "PHARMACIST" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: PH00065407 . This is a "PHARMACIST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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