Provider Demographics
NPI:1417263666
Name:DESAI, HEENA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEENA
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1062
Mailing Address - Country:US
Mailing Address - Phone:732-972-2309
Mailing Address - Fax:732-972-2529
Practice Address - Street 1:107 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1062
Practice Address - Country:US
Practice Address - Phone:732-972-2309
Practice Address - Fax:732-972-2529
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03335500183500000X
FLPS45231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist