MEDICARE: MR. HETAL DESAI RPH

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	183500000X	Pharmacist	28RI02586500	NJ

General Provider Information

NPI Number	:	1457597460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HETAL DESAI RPH

Provider Business Mailing Address
First Line	:	1 KNIGHTSBRIDGE PL
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-1271
Country	:	US
Telephone Number	:	732-905-8246
Fax Number	:

Provider Business Practice Location Address
First Line	:	739 GREENWOOD AVE
Second Line	:
City	:	TRENTON
State	:	NJ
Zip	:	08609-1401
Country	:	US
Telephone Number	:	609-989-1299
Fax Number	:	609-989-1126

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

Provider Enumeration Date	:	12/22/2008
Last Update Date	:	12/09/2011

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