Provider Demographics
NPI:1982384277
Name:PATRICK, DESTINY (RPH)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:PATRICK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3282 WARREN SHARON RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44473-9531
Mailing Address - Country:US
Mailing Address - Phone:330-984-1303
Mailing Address - Fax:
Practice Address - Street 1:4700 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1014
Practice Address - Country:US
Practice Address - Phone:330-759-9348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03443330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist