Provider Demographics
NPI:1750670329
Name:MEHTA, PURVISH MAHESHBHAI (RPH)
Entity Type:Individual
Prefix:
First Name:PURVISH
Middle Name:MAHESHBHAI
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 1:1509 S CANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6250
Mailing Address - Country:US
Mailing Address - Phone:704-298-0435
Mailing Address - Fax:
Practice Address - Street 1:1509 S CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6250
Practice Address - Country:US
Practice Address - Phone:704-298-0435
Practice Address - Fax:704-298-0435
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist