Provider Demographics
NPI:1013031723
Name:TESORO, DEBRA DENISE (RPH, BCOP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:DENISE
Last Name:TESORO
Suffix:
Gender:F
Credentials:RPH, BCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 LIMERICK LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203
Mailing Address - Country:US
Mailing Address - Phone:573-445-5909
Mailing Address - Fax:573-445-5924
Practice Address - Street 1:1705 E. BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-817-8527
Practice Address - Fax:573-449-4246
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0417581835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology