Individual
ANTHONY MICHAEL DESIVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
305 MAIN ST, HOLBROOK, NY 11741-1501
(631) 467-3444
Mailing address
23 DAKOTA ST, DEER PARK, NY 11729-2527
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
054915
NY
Other
Enumeration date
08/03/2010
Last updated
08/03/2010
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