Provider Demographics
NPI:1205104569
Name:GORADIA, SWETA UDAY
Entity type:Individual
Prefix:
First Name:SWETA
Middle Name:UDAY
Last Name:GORADIA
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:W173N10213 WOODBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4685
Mailing Address - Country:US
Mailing Address - Phone:262-251-9934
Mailing Address - Fax:
Practice Address - Street 1:4808 N HOPKINS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-5328
Practice Address - Country:US
Practice Address - Phone:414-462-4310
Practice Address - Fax:414-462-3967
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14325-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist