Provider Demographics
NPI:1992743348
Name:TANGEN DRUG INC
Entity type:Organization
Organization Name:TANGEN DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMPESTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHRAMD
Authorized Official - Phone:715-483-3271
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-0430
Mailing Address - Country:US
Mailing Address - Phone:715-483-3271
Mailing Address - Fax:715-483-1847
Practice Address - Street 1:124 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-9243
Practice Address - Country:US
Practice Address - Phone:715-483-3271
Practice Address - Fax:715-483-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WI5271-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2113064OtherPK
MN05810857900Medicaid
WI33100300Medicaid