Provider Demographics
NPI:1902110174
Name:DESIMONE, LUCIA
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:DESIMONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-3404
Mailing Address - Country:US
Mailing Address - Phone:215-345-1020
Mailing Address - Fax:215-230-5332
Practice Address - Street 1:400 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-3404
Practice Address - Country:US
Practice Address - Phone:215-345-1020
Practice Address - Fax:215-230-5332
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038479L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist