Provider Demographics
NPI:1255846705
Name:MAHANT RX INC
Entity Type:Organization
Organization Name:MAHANT RX INC
Other - Org Name:BELLE GLADE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DHRUVANG
Authorized Official - Middle Name:BIPIN
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-571-9861
Mailing Address - Street 1:136 S MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-3424
Mailing Address - Country:US
Mailing Address - Phone:561-571-9861
Mailing Address - Fax:561-571-9105
Practice Address - Street 1:136 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-3424
Practice Address - Country:US
Practice Address - Phone:561-571-9861
Practice Address - Fax:561-571-9105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X, 333600000X
FLPH309833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023341800Medicaid