Provider Demographics
NPI:1447393509
Name:DESAI PHARMACY INC
Entity Type:Organization
Organization Name:DESAI PHARMACY INC
Other - Org Name:DESAI PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NARENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:773-522-2900
Mailing Address - Street 1:2859 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4456
Mailing Address - Country:US
Mailing Address - Phone:773-522-2900
Mailing Address - Fax:773-522-3385
Practice Address - Street 1:2859 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4456
Practice Address - Country:US
Practice Address - Phone:773-522-2900
Practice Address - Fax:773-522-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL054.0150853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2021500OtherPK
IL=========001Medicaid
2021500OtherPK