Provider Demographics
NPI:1457597460
Name:DESAI, HETAL (RPH)
Entity Type:Individual
Prefix:MR
First Name:HETAL
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KNIGHTSBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1271
Mailing Address - Country:US
Mailing Address - Phone:732-905-8246
Mailing Address - Fax:
Practice Address - Street 1:739 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08609-1401
Practice Address - Country:US
Practice Address - Phone:609-989-1299
Practice Address - Fax:609-989-1126
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02586500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist