Provider Demographics
NPI:1619303856
Name:DESAI, JIGISHA (PHARM D)
Entity Type:Individual
Prefix:
First Name:JIGISHA
Middle Name:
Last Name:DESAI
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 1:36510 SAGEBRUSH CT
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-6791
Mailing Address - Country:US
Mailing Address - Phone:815-759-4400
Mailing Address - Fax:815-759-8090
Practice Address - Street 1:36510 SAGEBRUSH CT
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-6791
Practice Address - Country:US
Practice Address - Phone:815-759-4400
Practice Address - Fax:815-759-8090
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist