MEDICARE: DR. SHITAL DESAI PHARM.D., BCPS

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	1835P1200X	Pharmacotherapy Pharmacist	051.288971	IL
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	45075	TX

General Provider Information

NPI Number	:	1598851073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHITAL DESAI PHARM.D., BCPS

Provider Business Mailing Address
First Line	:	6414 FANNIN ST
Second Line	:	STE G100
City	:	HOUSTON
State	:	TX
Zip	:	77030-1517
Country	:	US
Telephone Number	:	713-704-2626
Fax Number	:

Provider Business Practice Location Address
First Line	:	6414 FANNIN ST
Second Line	:	STE G100
City	:	HOUSTON
State	:	TX
Zip	:	77030-1517
Country	:	US
Telephone Number	:	713-704-2626
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/13/2012

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