Provider Demographics
NPI:1043303985
Name:DESAI, DHANSUKHLAL B (RPH)
Entity Type:Individual
Prefix:
First Name:DHANSUKHLAL
Middle Name:B
Last Name:DESAI
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 1:5412 E VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1636
Mailing Address - Country:US
Mailing Address - Phone:562-425-6434
Mailing Address - Fax:562-496-1088
Practice Address - Street 1:5412 E VILLAGE RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1636
Practice Address - Country:US
Practice Address - Phone:562-425-6434
Practice Address - Fax:562-496-1088
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH32783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA360270Medicaid
CAPHA360270Medicaid