Provider Demographics
NPI:1528612918
Name:TAN, ROY WILLIAM JR (PHARMD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:WILLIAM
Last Name:TAN
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 S QUAIL HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-7985
Mailing Address - Country:US
Mailing Address - Phone:520-409-8817
Mailing Address - Fax:
Practice Address - Street 1:3901 W COSTCO DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2864
Practice Address - Country:US
Practice Address - Phone:520-797-8190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist