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1043814254 NPI number — JESSE DESOTO PHARM.D, RPH

NPI Number: 1043814254
Health Care Provider/Practitioner: JESSE DESOTO PHARM.D, RPH

Information about “1043814254” NPI (JESSE DESOTO PHARM.D, RPH) exists in 1043814254 in HTML format HTML  |  1043814254 in plain Text format TXT  |  1043814254 in PDF (Portable Document Format) PDF  |  1043814254 in an XML format XML  formats.

NPI Number : 1043814254 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043814254",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DESOTO",
    "FirstName": "JESSE",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHARM.D, RPH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6984 HEPBURN RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CLEVELAND",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "44130-4802",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "216-536-8759",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "23351 LORAIN RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NORTH OLMSTED",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "44070-1696",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "440-686-1586",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/28/2020",
    "LastUpdateDate": "11/28/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "03334976",
        "LicenseNumberStateCode": "OH",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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