Provider Demographics
NPI:1780404699
Name:DACANAY, ROBERT M (PHARM D)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:DACANAY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10622 ALBERT DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4413
Mailing Address - Country:US
Mailing Address - Phone:209-601-9608
Mailing Address - Fax:
Practice Address - Street 1:10622 ALBERT DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4413
Practice Address - Country:US
Practice Address - Phone:209-601-9608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist