Provider Demographics
NPI:1720536394
Name:MODI, RONAK Y (PHARMD)
Entity Type:Individual
Prefix:
First Name:RONAK
Middle Name:Y
Last Name:MODI
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 1:18 BOULDEN CIR STE 22
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3494
Mailing Address - Country:US
Mailing Address - Phone:302-322-0219
Mailing Address - Fax:
Practice Address - Street 1:18 BOULDEN CIR STE 22
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3494
Practice Address - Country:US
Practice Address - Phone:302-322-0219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0004993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist