Provider Demographics
NPI:1891020715
Name:DRAUGALIS, PAUL THOMAS (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:DRAUGALIS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W ENCANTO BLVD
Mailing Address - Street 2:# 612
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1256
Mailing Address - Country:US
Mailing Address - Phone:602-818-1046
Mailing Address - Fax:623-907-4990
Practice Address - Street 1:500 SDOUTH 99TH AVE.
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-9700
Practice Address - Country:US
Practice Address - Phone:623-907-4932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7619183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist