MEDICARE: DR. SONAL D MISTRY PHARM D

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	RPH04460	RI
2	183500000X	Pharmacist	0202207289	VA

General Provider Information

NPI Number	:	1639392418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONAL D MISTRY PHARM D

Provider Business Mailing Address
First Line	:	1128 MINERAL SPRING AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-4104
Country	:	US
Telephone Number	:	401-727-3900
Fax Number	:	401-727-4076

Provider Business Practice Location Address
First Line	:	1128 MINERAL SPRING AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-4104
Country	:	US
Telephone Number	:	401-727-3900
Fax Number	:	401-727-4076

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	12/28/2008

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