Provider Demographics
NPI:1790448702
Name:DANGOL, ANITA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:DANGOL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3608
Mailing Address - Country:US
Mailing Address - Phone:520-327-7239
Mailing Address - Fax:520-327-5228
Practice Address - Street 1:4700 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3608
Practice Address - Country:US
Practice Address - Phone:520-327-7239
Practice Address - Fax:520-327-5228
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist