Healthcare Provider Details

I. General information

NPI: 1821095704
Provider Name (Legal Business Name): MICHAEL JOHN CASTAGNO PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 WATERLOO RD
STOCKTON CA
95205-3738
US

IV. Provider business mailing address

5260 HILDRETH LN
STOCKTON CA
95212-2320
US

V. Phone/Fax

Practice location:
  • Phone: 209-466-2522
  • Fax: 209-466-2589
Mailing address:
  • Phone: 209-948-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHY45684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: