Provider Demographics
NPI:1992911903
Name:DESALVO, NANCY E (RPH)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:DESALVO
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 1:1225 S NAPER BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8312
Mailing Address - Country:US
Mailing Address - Phone:630-961-3246
Mailing Address - Fax:630-961-3446
Practice Address - Street 1:1225 S NAPER BLVD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8312
Practice Address - Country:US
Practice Address - Phone:630-961-3246
Practice Address - Fax:630-961-3446
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist