Provider Demographics
NPI:1528380920
Name:DESHMUKH, VAISHALI (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:VAISHALI
Middle Name:
Last Name:DESHMUKH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5504
Mailing Address - Country:US
Mailing Address - Phone:631-270-4953
Mailing Address - Fax:
Practice Address - Street 1:930 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-4901
Practice Address - Country:US
Practice Address - Phone:631-842-5381
Practice Address - Fax:631-789-0249
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist