Provider Demographics
NPI:1912556424
Name:SAPON, ALEX EMILIEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:EMILIEN
Last Name:SAPON
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 1:17301 E SPRING VALLEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:MAYER
Mailing Address - State:AZ
Mailing Address - Zip Code:86333-4263
Mailing Address - Country:US
Mailing Address - Phone:928-632-4080
Mailing Address - Fax:
Practice Address - Street 1:5845 W BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3871
Practice Address - Country:US
Practice Address - Phone:602-978-8323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist