Provider Demographics
NPI:1437495512
Name:MEHTA, CHIRAG M (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHIRAG
Middle Name:M
Last Name:MEHTA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:M
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1062 BROOMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8777
Mailing Address - Country:US
Mailing Address - Phone:714-287-6660
Mailing Address - Fax:
Practice Address - Street 1:6855 ALIANTE PKWY
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3195
Practice Address - Country:US
Practice Address - Phone:702-642-6062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17448183500000X
AZS017538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist