Individual
JAGDISH DESAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1608 W 69TH ST, CHICAGO, IL 60636-3316
(773) 778-3420
Mailing address
1608 W 69TH ST, CHICAGO, IL 60636-3316
(773) 778-3420
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051-033681
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
364309678
—
IL
Enumeration date
09/07/2016
Last updated
09/07/2016
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