MEDICARE: COTTONWOOD DE TUCSON 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	3336I0012X	Institutional Pharmacy	Y004261	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1992511	OTHER		PK

General Provider Information

NPI Number	:	1407904105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COTTONWOOD DE TUCSON INC

Provider Business Mailing Address
First Line	:	4110 W SWEETWATER DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-9348
Country	:	US
Telephone Number	:	520-743-2101
Fax Number	:	520-743-2184

Provider Business Practice Location Address
First Line	:	4110 W SWEETWATER DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-9348
Country	:	US
Telephone Number	:	520-743-2101
Fax Number	:	520-743-2184

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	JASON LASHBROOK
Credential	:	PHARM D
Telephone Number	:	520-743-2101

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	09/19/2025

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