Healthcare Provider Details

I. General information

NPI: 1194579771
Provider Name (Legal Business Name): DESIREE CROTEAU PHARMD, BCOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3400 SPRUCE ST GATES - 2ND FLOOR PHARMACY ADMINISTRATION
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 267-624-4643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number062943
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRP446090
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: