Provider Demographics
NPI:1427344613
Name:DESANTIS, KRISTEN (RPH)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:DESANTIS
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 1:5890 COUNTRY TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-5575
Mailing Address - Country:US
Mailing Address - Phone:330-797-0404
Mailing Address - Fax:
Practice Address - Street 1:5555 YOUNGSTOWN WARREN RD UNIT 950
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4846
Practice Address - Country:US
Practice Address - Phone:330-505-9463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist