Derek Distasio
Individual provider Active NPI Pharmacist · West Norriton, PA
NPI 1386464568 · NPPES record last updated Oct 14, 2024
Key facts
- NPI
- 1386464568
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RH459005 (PA)
- Practice address
- 2500 Boulevard of the Generals
West Norriton, PA 19403-3692 - Phone
- (610) 539-5093
- NPI assigned
- Oct 14, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RH459005 | PA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RH459005 | PA | Yes |
Addresses
Primary practice location
2500 Boulevard of the Generals
West Norriton, PA 19403-3692
Mailing address
2500 Boulevard of the Generals
West Norriton, PA 19403-3692
Phone (610) 539-5093
Other providers in West Norriton, PA
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- Joseph Cianciulli
- Eliese Delphin
- Divine Providence Village
- Diving Staffing Solutions LLC
- Morgan Fienman
- Daniela Figueroa
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All providers in West Norriton, PA · Pharmacist in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.