Provider Demographics
NPI:1609180702
Name:DISANG, STEPHEN AGNECIOUS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:AGNECIOUS
Last Name:DISANG
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 1:7114 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4332
Mailing Address - Country:US
Mailing Address - Phone:520-297-2826
Mailing Address - Fax:
Practice Address - Street 1:7114 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4332
Practice Address - Country:US
Practice Address - Phone:520-297-2826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist