Provider Demographics
NPI:1902251424
Name:DESAI, VISHAL AJITKUMAR (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:VISHAL
Middle Name:AJITKUMAR
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 1:352 FRANCE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2806
Mailing Address - Country:US
Mailing Address - Phone:860-930-7620
Mailing Address - Fax:
Practice Address - Street 1:352 FRANCE ST
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2806
Practice Address - Country:US
Practice Address - Phone:860-930-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist