MEDICARE: DR. SUMIT 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	183500000X	Pharmacist	RPH53579	CA

General Provider Information

NPI Number	:	1760602692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUMIT DESAI PHARM.D.

Provider Business Mailing Address
First Line	:	1823 COMMERCENTER W
Second Line	:	SUITE A
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3303
Country	:	US
Telephone Number	:	909-570-2339
Fax Number	:

Provider Business Practice Location Address
First Line	:	1823 COMMERCENTER W
Second Line	:	SUITE A
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3303
Country	:	US
Telephone Number	:	909-570-2339
Fax Number	:

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	11/14/2013

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