Provider Demographics
NPI:1760780159
Name:MODI, NIRALEE ATULKUMAR (MS, RPH)
Entity Type:Individual
Prefix:
First Name:NIRALEE
Middle Name:ATULKUMAR
Last Name:MODI
Suffix:
Gender:F
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 OAKTOWNE DR
Mailing Address - Street 2:UNIT B5
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5016 OLD TAR RD
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8436
Practice Address - Country:US
Practice Address - Phone:252-321-0649
Practice Address - Fax:252-321-7294
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist