Provider Demographics
NPI:1477875052
Name:MODI, DHARA A (RPH)
Entity Type:Individual
Prefix:
First Name:DHARA
Middle Name:A
Last Name:MODI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DHARA
Other - Middle Name:A
Other - Last Name:MODI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:460 MAMARONECK AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1802
Mailing Address - Country:US
Mailing Address - Phone:914-648-9121
Mailing Address - Fax:914-948-3519
Practice Address - Street 1:460 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1802
Practice Address - Country:US
Practice Address - Phone:914-648-9121
Practice Address - Fax:914-948-3519
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist