Provider Demographics
NPI:1932624400
Name:HAROLD, DESMOND ANTHONY (PHARMD)
Entity Type:Individual
Prefix:
First Name:DESMOND
Middle Name:ANTHONY
Last Name:HAROLD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MARCELL DR NE APT 9
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1380
Mailing Address - Country:US
Mailing Address - Phone:616-450-4347
Mailing Address - Fax:
Practice Address - Street 1:250 MARCELL DR NE APT 9
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1380
Practice Address - Country:US
Practice Address - Phone:616-450-4347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist