Provider Demographics
NPI:1538502968
Name:DESAUTELS, NEIL A (RPH)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:A
Last Name:DESAUTELS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 APPLE HILL LN
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-1127
Mailing Address - Country:US
Mailing Address - Phone:781-334-5481
Mailing Address - Fax:
Practice Address - Street 1:333 MAIN ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1727
Practice Address - Country:US
Practice Address - Phone:978-851-0437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
338950OtherNABP