Provider Demographics
NPI:1477263408
Name:ISAKOV, STEPHANIE ELENA
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELENA
Last Name:ISAKOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W MURIEL DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6523
Mailing Address - Country:US
Mailing Address - Phone:602-810-2689
Mailing Address - Fax:
Practice Address - Street 1:6611 W BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3607
Practice Address - Country:US
Practice Address - Phone:623-334-2940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist