Healthcare Provider Details

I. General information

NPI: 1417603572
Provider Name (Legal Business Name): JOHN DECRISTOFARO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 STATE RD
CINCINNATI OH
45255-2439
US

IV. Provider business mailing address

7500 STATE RD
CINCINNATI OH
45255-2439
US

V. Phone/Fax

Practice location:
  • Phone: 513-624-4669
  • Fax: 513-624-4813
Mailing address:
  • Phone: 513-624-4669
  • Fax: 513-624-4813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-328627
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: