Provider Demographics
NPI:1851564736
Name:DESARME, LESLY (RPH)
Entity Type:Individual
Prefix:
First Name:LESLY
Middle Name:
Last Name:DESARME
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 1:4737 ROUTE 209
Mailing Address - Street 2:LOT 2
Mailing Address - City:ACCORD
Mailing Address - State:NY
Mailing Address - Zip Code:12404-5754
Mailing Address - Country:US
Mailing Address - Phone:845-626-1278
Mailing Address - Fax:845-626-1177
Practice Address - Street 1:4737 ROUTE 209
Practice Address - Street 2:LOT 2
Practice Address - City:ACCORD
Practice Address - State:NY
Practice Address - Zip Code:12404-5754
Practice Address - Country:US
Practice Address - Phone:845-626-1278
Practice Address - Fax:845-626-1177
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist