Basic Information
Provider Information
NPI: 1659674075
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PINNIX
FirstName: TIFFANY
MiddleName: AMANDA MERRITT
NamePrefix: MRS.
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1701 WESTCHESTER DRIVE
Address2: SUITE 850
City: HIGH POINT
State: NC
PostalCode: 272627008
CountryCode: US
TelephoneNumber: 3368022400
FaxNumber: 3368022534
Practice Location
Address1: 1814 WESTCHESTER DRIVE
Address2: SUITE 301
City: HIGH POINT
State: NC
PostalCode: 272627369
CountryCode: US
TelephoneNumber: 3368022588
FaxNumber: 3368022340
Other Information
ProviderEnumerationDate: 12/07/2010
LastUpdateDate: 07/21/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X21045NCY Pharmacy Service ProvidersPharmacist 

No ID Information.


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