Provider Demographics
NPI:1396318820
Name:DESMOND, MICHAEL FOSTER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FOSTER
Last Name:DESMOND
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 1:500 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-1949
Mailing Address - Country:US
Mailing Address - Phone:270-274-9224
Mailing Address - Fax:270-274-9226
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-1949
Practice Address - Country:US
Practice Address - Phone:270-274-9224
Practice Address - Fax:270-274-9226
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist