Provider Demographics
NPI:1205004439
Name:MODI, KEYUR D (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEYUR
Middle Name:D
Last Name:MODI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 S FRIENDSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3915
Mailing Address - Country:US
Mailing Address - Phone:302-312-4510
Mailing Address - Fax:832-569-4756
Practice Address - Street 1:186 S FRIENDSWOOD DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3915
Practice Address - Country:US
Practice Address - Phone:302-312-4510
Practice Address - Fax:832-569-4756
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003134183500000X
PARP044959L183500000X
TX57421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX57421OtherBOARD OF PHARMACY
PARP044959LOtherSTATE LICENSE