Provider Demographics
NPI:1649868498
Name:DAGUANNO, DYLAN C (PHARMD)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:C
Last Name:DAGUANNO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:DYLAN
Other - Middle Name:C
Other - Last Name:D'AGUANNO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3843 INGRAHAM ST APT F110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-6442
Mailing Address - Country:US
Mailing Address - Phone:401-524-7525
Mailing Address - Fax:
Practice Address - Street 1:3350 PALM AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-1662
Practice Address - Country:US
Practice Address - Phone:619-424-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist