Healthcare Provider Details

I. General information

NPI: 1659761781
Provider Name (Legal Business Name): DEVANGKUMAR SUMANTRAI DESAI PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 PATRIOTS POINT DR
OCOEE FL
34761-3382
US

IV. Provider business mailing address

PO BOX 652
WINDERMERE FL
34786-0652
US

V. Phone/Fax

Practice location:
  • Phone: 407-749-4953
  • Fax:
Mailing address:
  • Phone: 407-749-4953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS36374
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH100001586
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: