Provider Demographics
NPI:1700299823
Name:DESAI, NICK NIKETAN (PHARMD)
Entity type:Individual
Prefix:MR
First Name:NICK
Middle Name:NIKETAN
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 1:522 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2409
Mailing Address - Country:US
Mailing Address - Phone:215-625-9840
Mailing Address - Fax:215-922-4469
Practice Address - Street 1:522 S 2ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-2409
Practice Address - Country:US
Practice Address - Phone:215-625-9840
Practice Address - Fax:215-922-4469
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist