Healthcare Provider Details

I. General information

NPI: 1982208690
Provider Name (Legal Business Name): DANIELLE LOUSSIA DESAI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 N ELSTON AVE
CHICAGO IL
60647-2019
US

IV. Provider business mailing address

2656 N ELSTON AVE
CHICAGO IL
60647-2019
US

V. Phone/Fax

Practice location:
  • Phone: 773-252-2210
  • Fax: 773-280-1012
Mailing address:
  • Phone: 773-252-2210
  • Fax: 773-289-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.300776
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: