Provider Demographics
NPI:1659974103
Name:MEHTA, JIGISHA
Entity Type:Individual
Prefix:
First Name:JIGISHA
Middle Name:
Last Name:MEHTA
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 1:158 PRADO LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-6315
Mailing Address - Country:US
Mailing Address - Phone:301-538-3302
Mailing Address - Fax:
Practice Address - Street 1:13490 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:COLESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20904-1224
Practice Address - Country:US
Practice Address - Phone:301-384-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist