Provider Demographics
NPI:1932489101
Name:AGNGARAYNGAY, EDWARD SAGISI
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SAGISI
Last Name:AGNGARAYNGAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1863 PERCY LN
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5923
Mailing Address - Country:US
Mailing Address - Phone:925-230-8423
Mailing Address - Fax:
Practice Address - Street 1:3250 W GRANT LINE RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-8427
Practice Address - Country:US
Practice Address - Phone:209-830-5342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist