Provider Demographics
NPI:1346790797
Name:DALAL, MITHIL KALPESH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MITHIL
Middle Name:KALPESH
Last Name:DALAL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13051 RAMONA AVE APT 53
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5929
Mailing Address - Country:US
Mailing Address - Phone:916-759-7581
Mailing Address - Fax:
Practice Address - Street 1:1241 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3681
Practice Address - Country:US
Practice Address - Phone:916-759-7581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist