Provider Demographics
NPI:1841806478
Name:RECASNER, DESHONDA DEVETTE
Entity Type:Individual
Prefix:
First Name:DESHONDA
Middle Name:DEVETTE
Last Name:RECASNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 CAMINO TRL
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6126
Mailing Address - Country:US
Mailing Address - Phone:214-870-3484
Mailing Address - Fax:
Practice Address - Street 1:8929 STATE HIGHWAY 34 S
Practice Address - Street 2:
Practice Address - City:QUINLAN
Practice Address - State:TX
Practice Address - Zip Code:75474-9437
Practice Address - Country:US
Practice Address - Phone:903-356-6020
Practice Address - Fax:866-559-4986
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty