Provider Demographics
NPI:1407904105
Name:COTTONWOOD DE TUCSON INC
Entity Type:Organization
Organization Name:COTTONWOOD DE TUCSON INC
Other - Org Name:COTTONWOOD DE TUCSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LASHBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:520-743-2101
Mailing Address - Street 1:4110 W SWEETWATER DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-9348
Mailing Address - Country:US
Mailing Address - Phone:520-743-2101
Mailing Address - Fax:520-743-2184
Practice Address - Street 1:4110 W SWEETWATER DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-9348
Practice Address - Country:US
Practice Address - Phone:520-743-2101
Practice Address - Fax:520-743-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0042613336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992511OtherPK