Provider Demographics
NPI:1760753263
Name:DESAI, NIMISHA J (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:NIMISHA
Middle Name:J
Last Name:DESAI
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 HANNAH WAY S
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-9454
Mailing Address - Country:US
Mailing Address - Phone:727-319-2757
Mailing Address - Fax:
Practice Address - Street 1:2309 HANNAH WAY S
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-9454
Practice Address - Country:US
Practice Address - Phone:727-408-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS47150OtherPHARMACIST