Provider Demographics
NPI:1649450305
Name:MEHTA, SANJAY PRAVIN (PHARMD)
Entity type:Individual
Prefix:
First Name:SANJAY
Middle Name:PRAVIN
Last Name:MEHTA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4070
Mailing Address - Country:US
Mailing Address - Phone:951-765-6505
Mailing Address - Fax:951-765-6522
Practice Address - Street 1:869 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4070
Practice Address - Country:US
Practice Address - Phone:951-765-6505
Practice Address - Fax:951-765-6522
Is Sole Proprietor?:No
Enumeration Date:2007-11-10
Last Update Date:2007-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist