Provider Demographics
NPI:1750688149
Name:MEHTA, ROOPAL NAMIT
Entity Type:Individual
Prefix:MRS
First Name:ROOPAL
Middle Name:NAMIT
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 1:624 VICKERY WAY NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4815
Mailing Address - Country:US
Mailing Address - Phone:404-663-1416
Mailing Address - Fax:
Practice Address - Street 1:3033 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5678
Practice Address - Country:US
Practice Address - Phone:770-518-4263
Practice Address - Fax:770-518-6809
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist