Healthcare Provider Details

I. General information

NPI: 1831290881
Provider Name (Legal Business Name): HARRY GERARD DESANTIS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NORTH GREENE STREET VA MEDICAL CENTER - PHARMACY DEPARTMENT
BALTIMORE MD
21201
US

IV. Provider business mailing address

405 TOWSON AVE
LUTHERVILLE MD
21093-4949
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7106
  • Fax:
Mailing address:
  • Phone: 410-561-5192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9102
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: