Provider Demographics
NPI:1821897935
Name:DESALVO, JACOB (PHARMD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:DESALVO
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 CITY GATE LN APT 163
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3720
Mailing Address - Country:US
Mailing Address - Phone:630-297-6219
Mailing Address - Fax:
Practice Address - Street 1:2132 CITY GATE LN APT 163
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3720
Practice Address - Country:US
Practice Address - Phone:630-297-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.304843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist