Provider Demographics
NPI:1376875799
Name:DEACETIS, DAVID PAUL
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PAUL
Last Name:DEACETIS
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 1:17 E JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3103
Mailing Address - Country:US
Mailing Address - Phone:516-873-1998
Mailing Address - Fax:516-873-7235
Practice Address - Street 1:17 E JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3103
Practice Address - Country:US
Practice Address - Phone:516-873-1998
Practice Address - Fax:516-873-7235
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist