Provider Demographics
NPI:1154433076
Name:DESAI DRUGS INC
Entity type:Organization
Organization Name:DESAI DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:909-570-2339
Mailing Address - Street 1:1823 COMMERCENTER W
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3303
Mailing Address - Country:US
Mailing Address - Phone:909-570-2339
Mailing Address - Fax:877-220-0199
Practice Address - Street 1:1823 COMMERCENTER W
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3303
Practice Address - Country:US
Practice Address - Phone:909-570-2339
Practice Address - Fax:877-220-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY482413336C0003X
COOSP.00064393336C0003X
AK1006463336C0003X
FLPH295333336C0003X
NC129663336C0003X
KS22-450913336C0003X
MO20160284173336C0003X
DEA9-00019343336C0003X
MN2652003336C0003X
GAPHNR0010533336C0003X
HIPMP-13413336C0003X
ID43844MS3336C0003X
IN64002232A3336C0003X
IA47663336C0003X
MTPHA-MOP-LIC-428113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2004808OtherPK
CAPHA482410Medicaid
2004808OtherPK