Provider Demographics
NPI:1598546681
Name:DESAI, MAYUR PARESHKUMAR (CPP)
Entity Type:Individual
Prefix:DR
First Name:MAYUR
Middle Name:PARESHKUMAR
Last Name:DESAI
Suffix:
Gender:M
Credentials:CPP
Other - Prefix:DR
Other - First Name:MAYUR
Other - Middle Name:PARESH
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 QUEENS RD STE 600
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3580
Practice Address - Country:US
Practice Address - Phone:980-305-6640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC700495183500000X, 1835P0018X
NC159961835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care