Individual
TIFFANY DENISE GERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
707 CHURCH ST, CONWAY, SC 29526-4824
(843) 248-6302
Mailing address
1827 ROAD 30, LAKE VIEW, SC 29563-5215
(267) 382-8435
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
42760
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH42760
LICENSE
SC
Enumeration date
11/22/2020
Last updated
11/22/2020
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