Provider Demographics
NPI:1619562428
Name:GIRARD, ELIZABETH ANGELA DEGIGLIO (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANGELA DEGIGLIO
Last Name:GIRARD
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:ANGELA
Other - Last Name:GIRARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:3642 HYACINTH DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-1104
Mailing Address - Country:US
Mailing Address - Phone:619-922-4228
Mailing Address - Fax:
Practice Address - Street 1:WHITE RIVER SERVICE UNIT
Practice Address - Street 2:INDIAN HEALTH SERVICE
Practice Address - City:WHITERIVER
Practice Address - State:AZ
Practice Address - Zip Code:85941
Practice Address - Country:US
Practice Address - Phone:619-922-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52409OtherPHARMACY LICENSE