MEDICARE: PRITAL MEHTA 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	23188	NC
2	183500000X	Pharmacist	14095	SC

General Provider Information

NPI Number	:	1881017291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRITAL MEHTA PHARM.D

Provider Business Mailing Address
First Line	:	1417 RIVERCHASE BLVD STE 103
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2493
Country	:	US
Telephone Number	:	803-970-6440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 RIVERCHASE BLVD STE 103
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2493
Country	:	US
Telephone Number	:	803-970-6440
Fax Number	:	803-970-6441

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

Provider Enumeration Date	:	01/22/2014
Last Update Date	:	12/18/2023

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