Provider Demographics
NPI:1528415213
Name:DESO, OLIVIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:DESO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5213
Mailing Address - Country:US
Mailing Address - Phone:831-375-5135
Mailing Address - Fax:831-375-6115
Practice Address - Street 1:2170 FREMONT ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5213
Practice Address - Country:US
Practice Address - Phone:831-375-5135
Practice Address - Fax:831-375-6115
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist