Provider Demographics
NPI:1386814101
Name:DESAI, RAVI (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2527
Mailing Address - Country:US
Mailing Address - Phone:607-756-2645
Mailing Address - Fax:
Practice Address - Street 1:2255 N. TRIPHAMMER RD.
Practice Address - Street 2:RITE AID PHARMACY 673
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-756-2645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027685-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist