Healthcare Provider Details

I. General information

NPI: 1629349212
Provider Name (Legal Business Name): PATRICK ANTHONY DISARNO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 82ND PKWY UNIT C
MYRTLE BEACH SC
29572-4607
US

IV. Provider business mailing address

823 82ND PKWY UNIT C
MYRTLE BEACH SC
29572-4607
US

V. Phone/Fax

Practice location:
  • Phone: 847-465-0951
  • Fax:
Mailing address:
  • Phone: 847-465-0951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-290824
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01886300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number36030
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: