Tad Gordon Itamura, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

26016350A Issued in IN

Practice address

505 E Thompson Rd
Indianapolis, IN 46227-1626

Phone

(317) 784-9716

Fax

(317) 780-7478

NPI assigned

Dec 3, 2020

Last updated

Dec 3, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1891390001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11026 TENACIOUS DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462369566",
            "telephone_number": "317-985-2077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 E THOMPSON RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462271626",
            "telephone_number": "317-784-9716",
            "fax_number": "317-780-7478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ITAMURA",
        "first_name": "TAD",
        "middle_name": "GORDON",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-03",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "IN",
            "license": "26016350A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Pharmacist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.