Provider Demographics
NPI:1689956781
Name:MEHTA, DHARMANG (PHARMD)
Entity Type:Individual
Prefix:
First Name:DHARMANG
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 BUXTON CIR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5132
Mailing Address - Country:US
Mailing Address - Phone:410-381-5609
Mailing Address - Fax:
Practice Address - Street 1:12400 AUTO DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-2200
Practice Address - Country:US
Practice Address - Phone:410-531-6030
Practice Address - Fax:410-531-7481
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist