Provider Demographics
NPI:1962799577
Name:KANTZOS, ELESA (RPH)
Entity type:Individual
Prefix:
First Name:ELESA
Middle Name:
Last Name:KANTZOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 N SCOTTSDALE RD
Mailing Address - Street 2:1010
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3658
Mailing Address - Country:US
Mailing Address - Phone:330-268-6590
Mailing Address - Fax:
Practice Address - Street 1:3931 S GILBERT RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-2004
Practice Address - Country:US
Practice Address - Phone:480-281-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-03
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist