Provider Demographics
NPI:1730725912
Name:VINTA, NEETHA
Entity type:Individual
Prefix:
First Name:NEETHA
Middle Name:
Last Name:VINTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17447 HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-9542
Mailing Address - Country:US
Mailing Address - Phone:248-662-3032
Mailing Address - Fax:248-662-3034
Practice Address - Street 1:17447 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-9542
Practice Address - Country:US
Practice Address - Phone:248-662-3032
Practice Address - Fax:248-662-3034
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020348521835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist