Provider Demographics
NPI:1609126770
Name:MAHETA, PURVI JIMIT
Entity Type:Individual
Prefix:
First Name:PURVI
Middle Name:JIMIT
Last Name:MAHETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 BLOSSOM HILL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1653
Mailing Address - Country:US
Mailing Address - Phone:408-768-9620
Mailing Address - Fax:408-224-8173
Practice Address - Street 1:393 BLOSSOM HILL RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1653
Practice Address - Country:US
Practice Address - Phone:408-768-9620
Practice Address - Fax:408-224-8173
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 55842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist