Komal Desai, PHARM.D
Individual provider Active NPI Pharmacist · White Bear Lake, MN
NPI 1093091019 · NPPES record last updated Oct 24, 2011
Key facts
- NPI
- 1093091019
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 120493 (MN)
- Practice address
- 915 Wildwood Rd
White Bear Lake, MN 55115-1847 - Phone
- (651) 426-7333
- NPI assigned
- Oct 24, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 120493 | MN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 120493 | MN | Yes |
Addresses
Primary practice location
915 Wildwood Rd
White Bear Lake, MN 55115-1847
Mailing address
915 Wildwood Rd
White Bear Lake, MN 55115-1847
Other providers in White Bear Lake, MN
- Crystal Erika-Kroells De Kam
- Dehaven Chiropractic Clinic, Inc
- Eric Demaris
- Dennis a. Smith & Associates, P. a.
- Scott Allen Depaulis
- Heather Rose Deutsch
- Catherine Agallo Deya
- Dieffenbach Counseling, PLLC
- Benjamin Dieffenbach
- Cristen Dilks
All providers in White Bear Lake, MN · Pharmacist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.