Provider Demographics
NPI:1982003406
Name:MEWADA, HETA
Entity Type:Individual
Prefix:
First Name:HETA
Middle Name:
Last Name:MEWADA
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 1:260 LAKE VILLAGE TRL
Mailing Address - Street 2:APT 306
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-1182
Mailing Address - Country:US
Mailing Address - Phone:773-682-8621
Mailing Address - Fax:
Practice Address - Street 1:260 LAKE VILLAGE TRL
Practice Address - Street 2:APT 306
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-1182
Practice Address - Country:US
Practice Address - Phone:773-682-8621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist