Provider Demographics
NPI:1912289604
Name:DESAI, JIGNESH A (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:JIGNESH
Middle Name:A
Last Name:DESAI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 N GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-2207
Mailing Address - Country:US
Mailing Address - Phone:201-218-0663
Mailing Address - Fax:
Practice Address - Street 1:508 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2207
Practice Address - Country:US
Practice Address - Phone:973-672-6317
Practice Address - Fax:973-673-6129
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02795200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist