=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508542689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TANDEM PHARMACY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2023
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1020 W MAIN ST # 100C
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83702-5789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-254-0154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 73 SPRING ST FL 3A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10012-5801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | SAHIR JAGGI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-855-7172
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------