Provider Demographics
NPI:1659761781
Name:DESAI, DEVANGKUMAR SUMANTRAI (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:DEVANGKUMAR
Middle Name:SUMANTRAI
Last Name:DESAI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-0652
Mailing Address - Country:US
Mailing Address - Phone:407-749-4953
Mailing Address - Fax:
Practice Address - Street 1:891 PATRIOTS POINT DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3382
Practice Address - Country:US
Practice Address - Phone:407-749-4953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36374183500000X
DCPH100001586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist