MEDICARE: PRIYANKA AJAYKUMAR DESAI PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	63572	CA

General Provider Information

NPI Number	:	1417261686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRIYANKA AJAYKUMAR DESAI PHARM.D.

Provider Business Mailing Address
First Line	:	2850 CHERRY WAY
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-1808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 CHERRY WAY
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-1808
Country	:	US
Telephone Number	:	815-735-0956
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2010
Last Update Date	:	07/30/2010

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