Provider Demographics
NPI:1497355853
Name:RATHOD, MITALBEN NIRAV (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MITALBEN
Middle Name:NIRAV
Last Name:RATHOD
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 E HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-8234
Mailing Address - Country:US
Mailing Address - Phone:813-675-3697
Mailing Address - Fax:813-675-3696
Practice Address - Street 1:1720 E HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-8234
Practice Address - Country:US
Practice Address - Phone:813-675-3697
Practice Address - Fax:813-675-3696
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist