Provider Demographics
NPI:1518442227
Name:VASOYA, DISHA
Entity Type:Individual
Prefix:
First Name:DISHA
Middle Name:
Last Name:VASOYA
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 1:1645 E COCONINO DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4753
Mailing Address - Country:US
Mailing Address - Phone:480-280-5484
Mailing Address - Fax:
Practice Address - Street 1:6951 S KINGS RANCH RD
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-3012
Practice Address - Country:US
Practice Address - Phone:480-288-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist