Provider Demographics
NPI:1932330974
Name:GANDHI, MITTAL Z
Entity Type:Individual
Prefix:
First Name:MITTAL
Middle Name:Z
Last Name:GANDHI
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 1:1475 WESTERN AVE
Mailing Address - Street 2:STUYVESANT PLAZA
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203
Mailing Address - Country:US
Mailing Address - Phone:518-482-8759
Mailing Address - Fax:
Practice Address - Street 1:1475 WESTERN AVE
Practice Address - Street 2:STUYVESANT PLAZA
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3520
Practice Address - Country:US
Practice Address - Phone:518-482-8759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist