Healthcare Provider Details

I. General information

NPI: 1861580136
Provider Name (Legal Business Name): BHARAT R DESAI R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST VA MEDIVAL CENTER HOSPITAL
DAYTON OH
45428-9000
US

IV. Provider business mailing address

6650 RANCH HILL DR
DAYTON OH
45415-1407
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax: 937-262-5963
Mailing address:
  • Phone: 837-890-8384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-2-19578
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: