Provider Demographics
NPI:1831290881
Name:DESANTIS, HARRY GERARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:GERARD
Last Name:DESANTIS
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 1:405 TOWSON AVE
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4949
Mailing Address - Country:US
Mailing Address - Phone:410-561-5192
Mailing Address - Fax:
Practice Address - Street 1:10 NORTH GREENE STREET
Practice Address - Street 2:VA MEDICAL CENTER - PHARMACY DEPARTMENT
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-605-7106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist