Provider Demographics
NPI:1326608936
Name:DESECKI, RICHARD W
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:DESECKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4339 DI PAOLO CTR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-5202
Mailing Address - Country:US
Mailing Address - Phone:847-299-1920
Mailing Address - Fax:
Practice Address - Street 1:4339 DI PAOLO CTR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-5202
Practice Address - Country:US
Practice Address - Phone:847-299-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051035855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist