Provider Demographics
NPI:1437443603
Name:SHAGENA, WILLIAM LESLIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LESLIE
Last Name:SHAGENA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41040 CALIFORNIA OAKS RD
Mailing Address - Street 2:T1283
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5749
Mailing Address - Country:US
Mailing Address - Phone:951-696-7612
Mailing Address - Fax:951-696-7612
Practice Address - Street 1:41040 CALIFORNIA OAKS RD
Practice Address - Street 2:T1283
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5749
Practice Address - Country:US
Practice Address - Phone:951-696-7612
Practice Address - Fax:951-696-7612
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH36509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist