Healthcare Provider Details

I. General information

NPI: 1659769586
Provider Name (Legal Business Name): ASAD PATANWALA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 N MARTIN AVE
TUCSON AZ
85721-0001
US

IV. Provider business mailing address

1295 N MARTIN AVE PO BOX 210202
TUCSON AZ
85721-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-5404
  • Fax: 520-626-7355
Mailing address:
  • Phone: 520-626-5404
  • Fax: 520-626-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS014232
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: