Provider Demographics
NPI:1831444561
Name:MODI, MITAL S (RPH)
Entity type:Individual
Prefix:MRS
First Name:MITAL
Middle Name:S
Last Name:MODI
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 1:8 BEGONIA CT
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-2128
Mailing Address - Country:US
Mailing Address - Phone:732-642-8485
Mailing Address - Fax:
Practice Address - Street 1:8 BEGONIA CT
Practice Address - Street 2:
Practice Address - City:SAYREVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08872-2128
Practice Address - Country:US
Practice Address - Phone:732-642-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03241500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist