Active NPI
Patrick A Tacderan, RPH
- Pharmacist
- Casa Grande, AZ
National Provider Identifier
1588974349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S011246
- Practice address
- 2021 N Pinal Ave
Casa Grande, AZ 85122-1417 - Phone
- (520) 876-0265
- Fax
- (520) 876-0532
- NPI assigned
- Oct 14, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S011246 | AZ | Primary |
| Pharmacist | 183500000X | 1113 | HI |
Addresses
Primary practice location
2021 N Pinal Ave
Casa Grande, AZ 85122-1417
Mailing address
941 W Saragosa St
Chandler, AZ 85225-6856
Phone (602) 309-4305
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S011246 | AZ | MD | Pharmacist |
| 1113 | HI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289001600000",
"number": "1588974349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "941 W SARAGOSA ST",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852256856",
"telephone_number": "602-309-4305",
"fax_number": "602-309-4305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2021 N PINAL AVE",
"city": "CASA GRANDE",
"state": "AZ",
"postal_code": "851221417",
"telephone_number": "520-876-0265",
"fax_number": "520-876-0532"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TACDERAN",
"first_name": "PATRICK",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-10-14",
"last_updated": "2010-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S011246",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "HI",
"license": "1113",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Casa Grande, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.