Provider Demographics
NPI:1235437005
Name:MANDAVIA, JIGNESH
Entity Type:Individual
Prefix:
First Name:JIGNESH
Middle Name:
Last Name:MANDAVIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 WEDDINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-6665
Mailing Address - Country:US
Mailing Address - Phone:704-246-6376
Mailing Address - Fax:704-849-7206
Practice Address - Street 1:10215 MCINTYRE RIDGE RD
Practice Address - Street 2:101
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134
Practice Address - Country:US
Practice Address - Phone:704-831-9212
Practice Address - Fax:704-831-9214
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17809183500000X
NC18135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist