MEDICARE: MITESHKUMAR MARADIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	50845	TX

General Provider Information

NPI Number	:	1558647958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITESHKUMAR MARADIA

Provider Business Mailing Address
First Line	:	2930 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-6907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2930 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-6907
Country	:	US
Telephone Number	:	806-698-2234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2011
Last Update Date	:	11/03/2021

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Directions to “ MITESHKUMAR MARADIA ” Practice Location

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