Provider Demographics
NPI:1285209452
Name:MODI, HARDIK M
Entity Type:Individual
Prefix:
First Name:HARDIK
Middle Name:M
Last Name:MODI
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 1:636 VALLEY MALL PKWY STE 7
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-4898
Mailing Address - Country:US
Mailing Address - Phone:509-888-7797
Mailing Address - Fax:509-672-0033
Practice Address - Street 1:636 VALLEY MALL PKWY STE 7
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-4898
Practice Address - Country:US
Practice Address - Phone:509-888-7797
Practice Address - Fax:509-672-0033
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA30163934183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician