Provider Demographics
NPI:1831406503
Name:DESAI, BHAVINA (PHARMD)
Entity type:Individual
Prefix:
First Name:BHAVINA
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12309 SILVER CUP CT
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-6479
Mailing Address - Country:US
Mailing Address - Phone:908-463-7050
Mailing Address - Fax:
Practice Address - Street 1:3463 SWEET AIR RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131-1825
Practice Address - Country:US
Practice Address - Phone:410-666-8220
Practice Address - Fax:410-666-9872
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19609183500000X
NJ28RI03322400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist