Provider Demographics
NPI:1649582305
Name:MEHTA, JATIN KIRTIKUMAR (RPH)
Entity Type:Individual
Prefix:
First Name:JATIN
Middle Name:KIRTIKUMAR
Last Name:MEHTA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 CARLISLE CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1761
Mailing Address - Country:US
Mailing Address - Phone:925-516-9068
Mailing Address - Fax:925-522-0155
Practice Address - Street 1:4100 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6201
Practice Address - Country:US
Practice Address - Phone:925-522-0150
Practice Address - Fax:925-522-0155
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist