Provider Demographics
NPI:1598217622
Name:MEHTA, JAYESH (MPHARM, RPH)
Entity Type:Individual
Prefix:
First Name:JAYESH
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MPHARM, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2276 OSPREY AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6522
Mailing Address - Country:US
Mailing Address - Phone:407-729-2870
Mailing Address - Fax:
Practice Address - Street 1:1240 PROVIDENCE BLVD
Practice Address - Street 2:UNIT 1 & 2
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725
Practice Address - Country:US
Practice Address - Phone:386-259-5435
Practice Address - Fax:386-259-9582
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450002183500000X
FLPS61838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist