Provider Demographics
NPI:1740885763
Name:PETIGARA, MONA PATEL (RPH)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:PATEL
Last Name:PETIGARA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 S VALLEY MILLS DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76711-1683
Mailing Address - Country:US
Mailing Address - Phone:254-756-1876
Mailing Address - Fax:
Practice Address - Street 1:1513 S VALLEY MILLS DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:TX
Practice Address - Zip Code:76711-1683
Practice Address - Country:US
Practice Address - Phone:254-756-1876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist