Provider Demographics
NPI:1477211100
Name:AGUAYO, ROBERTO (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:AGUAYO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 TRIPOLI DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86404-1527
Mailing Address - Country:US
Mailing Address - Phone:928-230-3836
Mailing Address - Fax:
Practice Address - Street 1:1980 MCCULLOCH BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-0969
Practice Address - Country:US
Practice Address - Phone:928-854-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20930183500000X
AZS025444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist