Provider Demographics
NPI:1194886259
Name:TATUM DRUGS INC
Entity type:Organization
Organization Name:TATUM DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP AND PHCST
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:480-473-9746
Mailing Address - Street 1:28248 N TATUM BLVD
Mailing Address - Street 2:STE B4
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-6343
Mailing Address - Country:US
Mailing Address - Phone:480-473-9746
Mailing Address - Fax:480-473-9707
Practice Address - Street 1:28248 N TATUM BLVD
Practice Address - Street 2:STE B4
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-6343
Practice Address - Country:US
Practice Address - Phone:480-473-9746
Practice Address - Fax:480-473-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
AZ37173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ808149Medicaid
0327191OtherNCPDP PROVIDER IDENTIFICATION NUMBER