MEDICARE: CAVALIER PHARMA GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0201002458	VA

General Provider Information

NPI Number	:	1023139714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAVALIER PHARMA GROUP INC

Provider Business Mailing Address
First Line	:	425 W WASHINGTON ST
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-5320
Country	:	US
Telephone Number	:	757-925-2014
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 W WASHINGTON ST
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-5320
Country	:	US
Telephone Number	:	757-925-2014
Fax Number	:

Authorized Official
Title or Position	:	PRES
Name	:	MR. WILLIAM LOUIS TATUM JR.
Credential	:
Telephone Number	:	757-925-2014

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	08/22/2020

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