Tiffany Druivenga
Individual provider Active NPI Pharmacist · Pella, IA
NPI 1083239396 · NPPES record last updated Jun 11, 2020
Key facts
- NPI
- 1083239396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 21097 (IA)
- Practice address
- 1650 Washington St
Pella, IA 50219-7573 - Phone
- (641) 628-9227
- NPI assigned
- Jun 11, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21097 | IA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past |
Accepting new patients | |
| Walmart Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 21097 | IA | Yes |
Addresses
Primary practice location
1650 Washington St
Pella, IA 50219-7573
Mailing address
5542 Arbor Lake Dr
Pleasant Hill, IA 50327-8525
Other providers in Pella, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.