Healthcare Provider Details

I. General information

NPI: 1982979696
Provider Name (Legal Business Name): KATHRYN DESIMONE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

4520 ROCKY RIVER RD W
JACKSONVILLE FL
32224-7623
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-1552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPS44055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: