Susan Marie Desanto, RPH
Individual provider Active NPI Pharmacist · Park Forest, IL
NPI 1831474451 · NPPES record last updated Oct 14, 2011
Key facts
- NPI
- 1831474451
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051-034388 (IL)
- Practice address
- 15 S Orchard Dr
Park Forest, IL 60466-2096 - Phone
- (708) 481-7878
- Fax
- (708) 481-3732
- NPI assigned
- Oct 14, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051-034388 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051-034388 | IL | Yes |
Addresses
Primary practice location
15 S Orchard Dr
Park Forest, IL 60466-2096
Mailing address
15 S Orchard Dr
Park Forest, IL 60466-2096
Phone (708) 481-7878
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 051-034388 | Other | IL | LICENSE NUMBER |
Other providers in Park Forest, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2011. 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.