Provider Demographics
NPI:1346984457
Name:ESTIGOY, MARK ANTHONY TUASON (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MARK ANTHONY
Middle Name:TUASON
Last Name:ESTIGOY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-5221
Mailing Address - Country:US
Mailing Address - Phone:928-669-6168
Mailing Address - Fax:
Practice Address - Street 1:131 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5221
Practice Address - Country:US
Practice Address - Phone:928-669-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist