Provider Demographics
NPI:1184126807
Name:TESORO, SALVATORE FRANCESCO (RPH)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:FRANCESCO
Last Name:TESORO
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 1:604 OLD 63 N
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4557
Mailing Address - Country:US
Mailing Address - Phone:573-499-6615
Mailing Address - Fax:573-499-6654
Practice Address - Street 1:604 OLD 63 N
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4557
Practice Address - Country:US
Practice Address - Phone:573-499-6615
Practice Address - Fax:573-499-6654
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist