Provider Demographics
NPI:1306440920
Name:DESALVO, PATRICE NICOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:NICOLE
Last Name:DESALVO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 LAKEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1884
Mailing Address - Country:US
Mailing Address - Phone:513-300-8765
Mailing Address - Fax:
Practice Address - Street 1:921 LILA AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-5706
Practice Address - Country:US
Practice Address - Phone:513-831-2623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03237040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist