Provider Demographics
NPI:1841891249
Name:DESAI, HIMANSHU HARIDUTT (RPH)
Entity type:Individual
Prefix:
First Name:HIMANSHU
Middle Name:HARIDUTT
Last Name:DESAI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:SANJAY
Other - Middle Name:
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1150 HAMMOND CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7806
Mailing Address - Country:US
Mailing Address - Phone:912-308-7309
Mailing Address - Fax:
Practice Address - Street 1:30983 US-441 S
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529
Practice Address - Country:US
Practice Address - Phone:706-335-7818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist