Provider Demographics
NPI:1447531702
Name:MEHTA, PRIYABEN S (PHARM D)
Entity type:Individual
Prefix:DR
First Name:PRIYABEN
Middle Name:S
Last Name:MEHTA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 NATCHEZ WAY
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-2930
Mailing Address - Country:US
Mailing Address - Phone:678-472-4275
Mailing Address - Fax:770-785-7257
Practice Address - Street 1:1510 MILSTEAD AVE NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-8030
Practice Address - Country:US
Practice Address - Phone:770-785-7128
Practice Address - Fax:770-785-7257
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist