Provider Demographics
NPI:1043814254
Name:DESOTO, JESSE (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:DESOTO
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6984 HEPBURN RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-4802
Mailing Address - Country:US
Mailing Address - Phone:216-536-8759
Mailing Address - Fax:
Practice Address - Street 1:23351 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-1696
Practice Address - Country:US
Practice Address - Phone:440-686-1586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03334976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist