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General NPI Number Information
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NPI Number | 1740884949
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Entity Type | Individual
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Provider Name | DESTA ABAY PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/28/2020
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Last Update Date | 11/28/2020
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Provider Practice Location Address
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Address Line | 4548 E MAIN ST
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City | WHITEHALL
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State | OH
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Zip | 43213-3039
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Country | US
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Telephone | 614-235-7076
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Fax |
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Provider Business Mailing Address
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Address Line | 6871 KINSTON DR
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City | CANAL WINCHESTER
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State | OH
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Zip | 43110-9325
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Country | US
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Telephone | 614-439-9389
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03439121
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License Number State | OH
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