Provider Demographics
NPI:1831735174
Name:MODI, SAURIN C (RPH)
Entity type:Individual
Prefix:
First Name:SAURIN
Middle Name:C
Last Name:MODI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5662 VINTAGE VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-4074
Mailing Address - Country:US
Mailing Address - Phone:863-255-8593
Mailing Address - Fax:
Practice Address - Street 1:2120 US HIGHWAY 92 W
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-3923
Practice Address - Country:US
Practice Address - Phone:863-551-3536
Practice Address - Fax:863-551-9178
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist