Provider Demographics
NPI:1497461909
Name:MEHTA, ANNA KHATSKO (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KHATSKO
Last Name:MEHTA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6236 TURNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-9703
Mailing Address - Country:US
Mailing Address - Phone:646-358-2632
Mailing Address - Fax:
Practice Address - Street 1:312 FAYETTE ST
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-1609
Practice Address - Country:US
Practice Address - Phone:315-682-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist