MEDICARE: JAYESH MEHTA MPHARM, RPH

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	RP450002	PA
2	183500000X	Pharmacist	PS61838	FL

General Provider Information

NPI Number	:	1598217622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYESH MEHTA MPHARM, RPH

Provider Business Mailing Address
First Line	:	2276 OSPREY AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6522
Country	:	US
Telephone Number	:	407-729-2870
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 PROVIDENCE BLVD
Second Line	:	UNIT 1 & 2
City	:	DELTONA
State	:	FL
Zip	:	32725
Country	:	US
Telephone Number	:	386-259-5435
Fax Number	:	386-259-9582

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

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	01/05/2022

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