Provider Demographics
NPI:1427133651
Name:DE SANTIS, DEBRA LEE (RPH)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:LEE
Last Name:DE SANTIS
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 1:8709 GALENA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-1715
Mailing Address - Country:US
Mailing Address - Phone:915-782-6328
Mailing Address - Fax:915-782-6329
Practice Address - Street 1:6700 DELTA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-5506
Practice Address - Country:US
Practice Address - Phone:915-782-6328
Practice Address - Fax:905-782-6329
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist