Provider Demographics
NPI:1649612706
Name:DESTITO, JENNA (PHARM D)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:DESTITO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:SAVACHKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:301 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212
Mailing Address - Country:US
Mailing Address - Phone:315-457-2531
Mailing Address - Fax:
Practice Address - Street 1:8411 SENECA TPKE STE 104
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-4912
Practice Address - Country:US
Practice Address - Phone:315-724-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059308183500000X
AZS019899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist