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Individual

TIFFANY NICOLE MCILWAIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1952 W DALLAS AVE, SELMA, AL 36701-7027
(334) 872-7211
(334) 872-7016
Mailing address
296 POLITIC RD, ELMORE, AL 36025-1340
(256) 452-5723

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
858770
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
858770
PHARMACIST LICENSE NUMBER
AL
Enumeration date
10/22/2020
Last updated
10/22/2020
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