Provider Demographics
NPI:1750376000
Name:DESIENO, JOHN (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DESIENO
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 1:211 SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-3611
Mailing Address - Country:US
Mailing Address - Phone:518-346-8435
Mailing Address - Fax:
Practice Address - Street 1:847 COUNTY HIGHWAY 122
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-6413
Practice Address - Country:US
Practice Address - Phone:518-773-3400
Practice Address - Fax:518-725-4764
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist