Provider Demographics
NPI:1184804080
Name:DESMONIE, DAVID RALPH
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RALPH
Last Name:DESMONIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BALMORAL CT
Mailing Address - Street 2:
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184-5001
Mailing Address - Country:US
Mailing Address - Phone:518-784-2505
Mailing Address - Fax:
Practice Address - Street 1:15 DARDESS DR
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12037-1439
Practice Address - Country:US
Practice Address - Phone:518-392-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046253-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist