Healthcare Provider Details

I. General information

NPI: 1346491099
Provider Name (Legal Business Name): BHAVIN KANTILAL MISTRY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WABASH AVE
AKRON OH
44307-2433
US

IV. Provider business mailing address

3475 BENT TREE LN APT 309
STOW OH
44224-2981
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-1152
  • Fax:
Mailing address:
  • Phone: 330-344-1152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH.03328972-3
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH.03328972-3
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: