Provider Demographics
NPI:1336660919
Name:MEHTA, MANISH (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4723 BIRCHFIELD LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-0635
Mailing Address - Country:US
Mailing Address - Phone:352-428-5641
Mailing Address - Fax:
Practice Address - Street 1:10507 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-5047
Practice Address - Country:US
Practice Address - Phone:352-596-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist