Provider Demographics
NPI:1427656677
Name:SAZONOV, STANISLAV ANATOLYEVICH (PHARMD)
Entity type:Individual
Prefix:MR
First Name:STANISLAV
Middle Name:ANATOLYEVICH
Last Name:SAZONOV
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 1:1654 N PEBBLE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2571
Mailing Address - Country:US
Mailing Address - Phone:623-207-6808
Mailing Address - Fax:
Practice Address - Street 1:1654 N PEBBLE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2571
Practice Address - Country:US
Practice Address - Phone:623-207-6808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-10
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist