Provider Demographics
NPI:1083337562
Name:MISTRY, KETAKUMARI (PHARM D RPH)
Entity Type:Individual
Prefix:DR
First Name:KETAKUMARI
Middle Name:
Last Name:MISTRY
Suffix:
Gender:F
Credentials:PHARM D RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 BAGDAD RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-6425
Mailing Address - Country:US
Mailing Address - Phone:956-867-6787
Mailing Address - Fax:
Practice Address - Street 1:1950 BAGDAD RD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6425
Practice Address - Country:US
Practice Address - Phone:512-528-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist