Healthcare Provider Details

I. General information

NPI: 1821313164
Provider Name (Legal Business Name): LIZA MEHTA R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 DOUGHTY BLVD
INWOOD NY
11096-1345
US

IV. Provider business mailing address

1960 N COMMERCE PKWY STE 8
WESTON FL
33326-3247
US

V. Phone/Fax

Practice location:
  • Phone: 888-806-3379
  • Fax:
Mailing address:
  • Phone: 954-384-0847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRI02671300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS015373
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number050939
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: