Provider Demographics
NPI:1275935041
Name:DESAI, MALHAR C (RPH)
Entity Type:Individual
Prefix:
First Name:MALHAR
Middle Name:C
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 1:9802 WILDWOOD CIR
Mailing Address - Street 2:APT 1D
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3982
Mailing Address - Country:US
Mailing Address - Phone:813-440-9195
Mailing Address - Fax:
Practice Address - Street 1:9802 WILDWOOD CIR
Practice Address - Street 2:APT 1D
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3982
Practice Address - Country:US
Practice Address - Phone:813-440-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023433A183500000X
FLPS37409183500000X
IL051.293891183500000X
NJ28RI03340700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist