Individual
JOHN EDWARD DESTITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
105 SW 2ND AVE, MILTON FREEWATER, OR 97862-1373
(541) 938-8778
(541) 938-6072
Mailing address
246 KOKANEE DR, WALLA WALLA, WA 99362-5502
(509) 301-9651
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0017219
OR
Other
Enumeration date
05/29/2019
Last updated
05/29/2019
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