Basic Information
| Provider Information | |||||||||
| NPI: | 1891020715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRAUGALIS | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | PHARMACIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 W ENCANTO BLVD | ||||||||
| Address2: | # 612 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850031256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028181046 | ||||||||
| FaxNumber: | 6239074990 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 SDOUTH 99TH AVE. | ||||||||
| Address2: | |||||||||
| City: | TOLLESON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853539700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239074932 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2009 | ||||||||
| LastUpdateDate: | 10/09/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 7619 | AZ | N | Pharmacy Service Providers | Pharmacist | 1835P0018X | 7619 | AZ | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.