Provider Demographics
NPI:1821313164
Name:MEHTA, LIZA (RPH)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 N COMMERCE PKWY STE 8
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3247
Mailing Address - Country:US
Mailing Address - Phone:954-384-0847
Mailing Address - Fax:
Practice Address - Street 1:447 DOUGHTY BLVD
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:NY
Practice Address - Zip Code:11096-1345
Practice Address - Country:US
Practice Address - Phone:888-806-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI02671300183500000X
AZS015373183500000X
NY0509391835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist