Provider Demographics
NPI:1780288415
Name:DESAI, KALPESH AVINASH
Entity type:Individual
Prefix:MR
First Name:KALPESH
Middle Name:AVINASH
Last Name:DESAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2922
Mailing Address - Country:US
Mailing Address - Phone:210-228-9483
Mailing Address - Fax:210-228-9684
Practice Address - Street 1:300 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2922
Practice Address - Country:US
Practice Address - Phone:210-228-9483
Practice Address - Fax:210-228-9684
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist