Provider Demographics
NPI:1619757325
Name:DEBANO, WENDY SUE (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:DEBANO
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 E ROCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3244
Mailing Address - Country:US
Mailing Address - Phone:602-762-0076
Mailing Address - Fax:
Practice Address - Street 1:3551 E ROCKWOOD DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3244
Practice Address - Country:US
Practice Address - Phone:602-762-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS026691OtherARIZONA STATE BOARD OF PHARMACY, PHARMACIST LICENSE