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General NPI Number Information
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NPI Number | 1124268750
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Entity Type | Individual
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Provider Name | MIRA GOKHALE RPH
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Gender | Female
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Dates
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Enumeration Date | 02/22/2009
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Last Update Date | 02/22/2009
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Provider Practice Location Address
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Address Line | 1490 W CENTER RD
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City | ESSEXVILLE
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State | MI
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Zip | 48732-2112
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Country | US
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Telephone | 989-892-1565
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Fax |
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Provider Business Mailing Address
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Address Line | 7332 BLAKE DR
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City | BAY CITY
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State | MI
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Zip | 48706-8325
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Country | US
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Telephone | 989-326-0296
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302036073
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License Number State | MI
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