Healthcare Provider Details

I. General information

NPI: 1477263408
Provider Name (Legal Business Name): STEPHANIE ELENA ISAKOV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 W BELL RD
GLENDALE AZ
85308-3607
US

IV. Provider business mailing address

305 W MURIEL DR
PHOENIX AZ
85023-6523
US

V. Phone/Fax

Practice location:
  • Phone: 623-334-2940
  • Fax:
Mailing address:
  • Phone: 602-810-2689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS026185
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: