Provider Demographics
NPI:1982035515
Name:DESMARAIS, ALICIA MARIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:DESMARAIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:MARIE
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:27 ROUND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-1129
Mailing Address - Country:US
Mailing Address - Phone:518-899-2986
Mailing Address - Fax:518-899-6746
Practice Address - Street 1:27 ROUND LAKE RD
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1129
Practice Address - Country:US
Practice Address - Phone:518-899-2986
Practice Address - Fax:518-899-6746
Is Sole Proprietor?:No
Enumeration Date:2013-12-08
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058628183500000X
NYI058628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist