Provider Demographics
NPI:1821095704
Name:CASTAGNO, MICHAEL JOHN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:CASTAGNO
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 1:5260 HILDRETH LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-2320
Mailing Address - Country:US
Mailing Address - Phone:209-948-0950
Mailing Address - Fax:
Practice Address - Street 1:1530 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-3738
Practice Address - Country:US
Practice Address - Phone:209-466-2522
Practice Address - Fax:209-466-2589
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY45684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-3413314OtherFEDERAL TAX ID
CA4675120001Medicare ID - Type UnspecifiedMEDICARE