Provider Demographics
NPI:1639392418
Name:MISTRY, SONAL D (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SONAL
Middle Name:D
Last Name:MISTRY
Suffix:
Gender:F
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 1:1128 MINERAL SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4104
Mailing Address - Country:US
Mailing Address - Phone:401-727-3900
Mailing Address - Fax:401-727-4076
Practice Address - Street 1:1128 MINERAL SPRING AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4104
Practice Address - Country:US
Practice Address - Phone:401-727-3900
Practice Address - Fax:401-727-4076
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04460183500000X
VA0202207289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist