MEDICARE: MR. WILLIAM DAVID TARLOFF RPH

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	14011	AZ

General Provider Information

NPI Number	:	1467507954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM DAVID TARLOFF RPH

Provider Business Mailing Address
First Line	:	2935 TIERRA VIDA
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86429-5827
Country	:	US
Telephone Number	:	928-754-5440
Fax Number	:	928-754-5441

Provider Business Practice Location Address
First Line	:	1751 HIGHWAY 95
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-6902
Country	:	US
Telephone Number	:	928-763-1888
Fax Number	:	928-763-5186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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