Provider Demographics
NPI:1275010019
Name:MISTRY, JIGNESHKUMAR R (PHARM D)
Entity Type:Individual
Prefix:
First Name:JIGNESHKUMAR
Middle Name:R
Last Name:MISTRY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11805 ALLFORTH LN APT 2105
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4083
Mailing Address - Country:US
Mailing Address - Phone:704-577-7972
Mailing Address - Fax:
Practice Address - Street 1:11805 ALLFORTH LN APT 2105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277
Practice Address - Country:US
Practice Address - Phone:704-577-7972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty