Provider Demographics
NPI:1598176778
Name:MODI, DEVANG N (RPH,MS)
Entity Type:Individual
Prefix:
First Name:DEVANG
Middle Name:N
Last Name:MODI
Suffix:
Gender:M
Credentials:RPH,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 PALM BAY RD STE 108
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3863
Mailing Address - Country:US
Mailing Address - Phone:201-993-5814
Mailing Address - Fax:321-499-3994
Practice Address - Street 1:5055 BABCOCK ST NE
Practice Address - Street 2:SUITE 3
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4673
Practice Address - Country:US
Practice Address - Phone:201-993-5814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH27315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist