=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134212749
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAILESH JAYANTILAL DESAI PHARMACIST
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3625 W ROOSEVELT RD
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60624-4226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-277-8995
-----------------------------------------------------
Fax | 773-277-8256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6908 GALWAY CT
-----------------------------------------------------
City | DARIEN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60561-3679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-810-9754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------