Provider Demographics
NPI:1235456682
Name:TAZ PHARMACIES CR, LLC
Entity Type:Organization
Organization Name:TAZ PHARMACIES CR, LLC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZOSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-752-7139
Mailing Address - Street 1:11 N 3RD AVE
Mailing Address - Street 2:BOX 696
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-1815
Mailing Address - Country:US
Mailing Address - Phone:641-752-7139
Mailing Address - Fax:
Practice Address - Street 1:2030 6TH ST SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-3564
Practice Address - Country:US
Practice Address - Phone:319-364-6930
Practice Address - Fax:319-261-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy