Provider Demographics
NPI:1760630487
Name:MISTRY, JYOTIKA HARISH
Entity Type:Individual
Prefix:MRS
First Name:JYOTIKA
Middle Name:HARISH
Last Name:MISTRY
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 1:1703 HAGGERTY HWY
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-2833
Mailing Address - Country:US
Mailing Address - Phone:248-926-3133
Mailing Address - Fax:248-926-3165
Practice Address - Street 1:1703 HAGGERTY HWY
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-2833
Practice Address - Country:US
Practice Address - Phone:248-926-3133
Practice Address - Fax:248-926-3165
Is Sole Proprietor?:No
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist