Individual
DHVANI DERASARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13737 NOEL RD, #1200, DALLAS, TX 75240
(682) 559-8205
Mailing address
13737 NOEL RD, #1200, DALLAS, TX 75240
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34360
TEXAS STATE BOARD OF PHARMACY
TX
Enumeration date
10/10/2016
Last updated
02/08/2017
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