Provider Demographics
NPI:1437440344
Name:DESAI, MANOJKUMAR MADHUKANT
Entity Type:Individual
Prefix:DR
First Name:MANOJKUMAR
Middle Name:MADHUKANT
Last Name:DESAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13B VEAZIE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-2320
Mailing Address - Country:US
Mailing Address - Phone:518-269-6481
Mailing Address - Fax:
Practice Address - Street 1:13B VEAZIE ST
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2320
Practice Address - Country:US
Practice Address - Phone:518-269-6481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist