Provider Demographics
NPI:1245057868
Name:MODI, ALOK (PHARMD)
Entity type:Individual
Prefix:
First Name:ALOK
Middle Name:
Last Name:MODI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 OLIVEWOOD DR APT 6
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-1227
Mailing Address - Country:US
Mailing Address - Phone:510-415-1609
Mailing Address - Fax:
Practice Address - Street 1:649 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2424
Practice Address - Country:US
Practice Address - Phone:209-723-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist