Provider Demographics
NPI:1023440203
Name:DESAI, ANKITKUMAR (PHARMD)
Entity type:Individual
Prefix:
First Name:ANKITKUMAR
Middle Name:
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 1:611 W ROOSEVELT BLVD
Mailing Address - Street 2:APT 127
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-3434
Mailing Address - Country:US
Mailing Address - Phone:704-340-8004
Mailing Address - Fax:
Practice Address - Street 1:1101 WOODRDG CTR DR
Practice Address - Street 2:SUITE 114
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-1952
Practice Address - Country:US
Practice Address - Phone:704-821-1589
Practice Address - Fax:704-821-1645
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist