Provider Demographics
NPI:1578985008
Name:DURAZO, ENRIQUE ERNEST (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:ERNEST
Last Name:DURAZO
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 1:100 W WHITE PARK DR
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-1021
Mailing Address - Country:US
Mailing Address - Phone:520-281-2594
Mailing Address - Fax:
Practice Address - Street 1:100 W WHITE PARK DR
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-1021
Practice Address - Country:US
Practice Address - Phone:520-281-2594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist