Provider Demographics
NPI:1023417672
Name:DESAI, UTKARSH SUKETU (PHARMD)
Entity type:Individual
Prefix:
First Name:UTKARSH
Middle Name:SUKETU
Last Name:DESAI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 TEACHERS WAY APT 1099
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3266
Mailing Address - Country:US
Mailing Address - Phone:850-524-5975
Mailing Address - Fax:
Practice Address - Street 1:12215 DARNESTOWN RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2203
Practice Address - Country:US
Practice Address - Phone:301-948-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22733183500000X
VA0202213105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist