Provider Demographics
NPI:1417316993
Name:DESAI, KESHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KESHA
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 1:137 SAPPHIRE LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-1646
Mailing Address - Country:US
Mailing Address - Phone:732-629-6291
Mailing Address - Fax:
Practice Address - Street 1:137 SAPPHIRE LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-1646
Practice Address - Country:US
Practice Address - Phone:732-629-6291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03729800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist