Provider Demographics
NPI:1487904736
Name:DESARMO, REBEKAH LYN (PHARM D, MBA)
Entity type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:LYN
Last Name:DESARMO
Suffix:
Gender:F
Credentials:PHARM D, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4171 S OCEANA DR
Mailing Address - Street 2:
Mailing Address - City:NEW ERA
Mailing Address - State:MI
Mailing Address - Zip Code:49446
Mailing Address - Country:US
Mailing Address - Phone:231-861-6900
Mailing Address - Fax:231-452-6472
Practice Address - Street 1:4171 S OCEANA DR
Practice Address - Street 2:
Practice Address - City:NEW ERA
Practice Address - State:MI
Practice Address - Zip Code:49446
Practice Address - Country:US
Practice Address - Phone:231-861-6900
Practice Address - Fax:231-452-6472
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist