Provider Demographics
NPI:1477939288
Name:DESTAN, SABOET (RPH)
Entity Type:Individual
Prefix:
First Name:SABOET
Middle Name:
Last Name:DESTAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SABOET
Other - Middle Name:
Other - Last Name:ELMAZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:7 STONY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1030
Mailing Address - Country:US
Mailing Address - Phone:203-448-1030
Mailing Address - Fax:
Practice Address - Street 1:7 STONY HILL RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1030
Practice Address - Country:US
Practice Address - Phone:203-448-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist