Provider Demographics
NPI:1174335657
Name:DESABLA, ANDREW CRAIG (RPH)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CRAIG
Last Name:DESABLA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17526 PRETTY BOY DAM RD
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21120-9636
Mailing Address - Country:US
Mailing Address - Phone:443-895-8888
Mailing Address - Fax:
Practice Address - Street 1:8302 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-3124
Practice Address - Country:US
Practice Address - Phone:410-655-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist