Provider Demographics
NPI:1366710071
Name:ABOAGYE, TIFFANY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:ABOAGYE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 MARIGOLD DR
Mailing Address - Street 2:APT 235
Mailing Address - City:SAUK VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60411-5252
Mailing Address - Country:US
Mailing Address - Phone:708-753-1308
Mailing Address - Fax:
Practice Address - Street 1:2611 MARIGOLD DR
Practice Address - Street 2:APT 235
Practice Address - City:SAUK VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60411-5252
Practice Address - Country:US
Practice Address - Phone:708-753-1308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051294711183500000X
IN26023824A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist