Provider Demographics
NPI:1184046104
Name:MEHTA, SHWETAL C (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:SHWETAL
Middle Name:C
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 1:408 NE 81ST ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8111
Mailing Address - Country:US
Mailing Address - Phone:360-574-1141
Mailing Address - Fax:
Practice Address - Street 1:408 NE 81ST ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8111
Practice Address - Country:US
Practice Address - Phone:360-574-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60423367183500000X
NY20 057355183500000X
ORRPH0013922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist