Provider Demographics
NPI:1760840904
Name:CHAUDHARI, MITALI
Entity Type:Individual
Prefix:
First Name:MITALI
Middle Name:
Last Name:CHAUDHARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MITALI
Other - Middle Name:
Other - Last Name:PATIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4539 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7800
Mailing Address - Country:US
Mailing Address - Phone:513-322-0303
Mailing Address - Fax:
Practice Address - Street 1:4539 S SHORE DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7800
Practice Address - Country:US
Practice Address - Phone:515-207-7793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRPH.03229856-21835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist