Healthcare Provider Details

I. General information

NPI: 1730161845
Provider Name (Legal Business Name): DAVID DESSENDER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 DEER RUN LN
MALVERN PA
19355-1613
US

IV. Provider business mailing address

21 DEER RUN LN
MALVERN PA
19355-1613
US

V. Phone/Fax

Practice location:
  • Phone: 610-761-4993
  • Fax:
Mailing address:
  • Phone: 610-761-4993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP040776L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: