Provider Demographics
NPI:1508149436
Name:MEHTA, NEEL (PHARM D)
Entity Type:Individual
Prefix:
First Name:NEEL
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16505 SIERRA LAKES PKWY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1256
Mailing Address - Country:US
Mailing Address - Phone:909-770-5648
Mailing Address - Fax:909-770-5645
Practice Address - Street 1:16505 SIERRA LAKES PKWY
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1256
Practice Address - Country:US
Practice Address - Phone:909-770-5648
Practice Address - Fax:909-770-5645
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist