Provider Demographics
NPI:1982957460
Name:MISTRY, SADHANA JAYESH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SADHANA
Middle Name:JAYESH
Last Name:MISTRY
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 1:370 S ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6221
Mailing Address - Country:US
Mailing Address - Phone:865-483-7164
Mailing Address - Fax:
Practice Address - Street 1:370 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6221
Practice Address - Country:US
Practice Address - Phone:865-483-7164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-20
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist