Provider Demographics
NPI:1417591983
Name:CHAUDHARI, MITTAL (RPH)
Entity Type:Individual
Prefix:
First Name:MITTAL
Middle Name:
Last Name:CHAUDHARI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9131 COLLEGE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4827
Mailing Address - Country:US
Mailing Address - Phone:239-267-2032
Mailing Address - Fax:
Practice Address - Street 1:9131 COLLEGE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4827
Practice Address - Country:US
Practice Address - Phone:239-267-2032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist