Provider Demographics
NPI:1003021627
Name:DESAI, SONAL SHAILEN (BPHARM)
Entity Type:Individual
Prefix:MRS
First Name:SONAL
Middle Name:SHAILEN
Last Name:DESAI
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 GIDDINGS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3800
Mailing Address - Country:US
Mailing Address - Phone:626-797-2481
Mailing Address - Fax:
Practice Address - Street 1:3551 GIDDINGS RANCH RD
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3800
Practice Address - Country:US
Practice Address - Phone:626-797-2481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist