Provider Demographics
NPI:1700053626
Name:DESAI, DAKSHA (BPHARM)
Entity Type:Individual
Prefix:MS
First Name:DAKSHA
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 POWERS FERRY RD. SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4287
Mailing Address - Country:US
Mailing Address - Phone:770-955-3474
Mailing Address - Fax:770-933-8414
Practice Address - Street 1:1122 POWERS FERRY RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5753
Practice Address - Country:US
Practice Address - Phone:770-955-3474
Practice Address - Fax:770-933-8414
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016216183500000X
TX25534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist