Healthcare Provider Details

I. General information

NPI: 1518721638
Provider Name (Legal Business Name): MAHVISH HODA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BRIAR VIEW RD
VESTAL NY
13850-5437
US

IV. Provider business mailing address

115 BRIAR VIEW RD
VESTAL NY
13850-5437
US

V. Phone/Fax

Practice location:
  • Phone: 607-972-1461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number070966
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number070966
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: