Provider Demographics
NPI:1043646680
Name:MEHTA, JIGNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JIGNA
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-0543
Mailing Address - Country:US
Mailing Address - Phone:781-985-2397
Mailing Address - Fax:
Practice Address - Street 1:399 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1536
Practice Address - Country:US
Practice Address - Phone:617-658-6421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-15
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-16291183500000X
MAPH234867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist