Provider Demographics
NPI:1699108696
Name:DESAI, MUKESH D (RPH)
Entity type:Individual
Prefix:
First Name:MUKESH
Middle Name:D
Last Name:DESAI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1693 LEE RD STE B
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2260
Mailing Address - Country:US
Mailing Address - Phone:407-622-5766
Mailing Address - Fax:407-622-5767
Practice Address - Street 1:1693 LEE RD STE B
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2260
Practice Address - Country:US
Practice Address - Phone:407-622-5766
Practice Address - Fax:407-622-5767
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS22811OtherPHARMACIST LISENCE