Healthcare Provider Details

I. General information

NPI: 1982115697
Provider Name (Legal Business Name): NEIL MEHTA PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 HIGHLAND RD STE 113
WATERFORD MI
48328-2163
US

IV. Provider business mailing address

4000 HIGHLAND RD STE 113
WATERFORD MI
48328-2163
US

V. Phone/Fax

Practice location:
  • Phone: 248-977-1394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302037037
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: