Provider Demographics
NPI:1972174803
Name:MODI, JAGRUTIBAHEN SOMABHAI
Entity Type:Individual
Prefix:
First Name:JAGRUTIBAHEN
Middle Name:SOMABHAI
Last Name:MODI
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 1:9906 SPRINGFIELD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1924
Mailing Address - Country:US
Mailing Address - Phone:713-304-1854
Mailing Address - Fax:
Practice Address - Street 1:101 SOUTHWESTERN BLVD STE 231
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4629
Practice Address - Country:US
Practice Address - Phone:281-277-7623
Practice Address - Fax:346-275-2366
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy