Provider Demographics
NPI:1215997234
Name:MEHTA, KERUL T
Entity type:Individual
Prefix:
First Name:KERUL
Middle Name:T
Last Name:MEHTA
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 1:165 HILLANDALE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1465
Mailing Address - Country:US
Mailing Address - Phone:630-926-5252
Mailing Address - Fax:630-582-0228
Practice Address - Street 1:165 HILLANDALE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1465
Practice Address - Country:US
Practice Address - Phone:630-926-5252
Practice Address - Fax:630-582-0228
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051286920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist