Provider Demographics
NPI:1104133024
Name:MODI, HEMAL R (RPH)
Entity type:Individual
Prefix:MR
First Name:HEMAL
Middle Name:R
Last Name:MODI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 EXCHANGE PL
Mailing Address - Street 2:APT #302
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1885
Mailing Address - Country:US
Mailing Address - Phone:919-302-7384
Mailing Address - Fax:
Practice Address - Street 1:1101 EXCHANGE PL
Practice Address - Street 2:APT #302
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1885
Practice Address - Country:US
Practice Address - Phone:919-302-7384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist