=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346333770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAZ TRADING COMPANY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2006
-----------------------------------------------------
Last Update Date | 02/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44260 ICE RINK PLZ STE 105
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20147-6040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-858-9616
-----------------------------------------------------
Fax | 703-858-9313
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44260 ICE RINK PLZ STE 105
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20147-6040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | THOMAS ZIEGLER
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 703-858-9616
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 0201004117
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------