Provider Demographics
NPI:1588974349
Name:TACDERAN, PATRICK A (RPH)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:A
Last Name:TACDERAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 W SARAGOSA ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-6856
Mailing Address - Country:US
Mailing Address - Phone:602-309-4305
Mailing Address - Fax:602-309-4305
Practice Address - Street 1:2021 N PINAL AVE
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-1417
Practice Address - Country:US
Practice Address - Phone:520-876-0265
Practice Address - Fax:520-876-0532
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011246183500000X
HI1113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist