Provider Demographics
NPI:1285127290
Name:UPADHYAY, HITESH P
Entity type:Individual
Prefix:
First Name:HITESH
Middle Name:P
Last Name:UPADHYAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23832 SOUTHFIELD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-8001
Mailing Address - Country:US
Mailing Address - Phone:248-557-9333
Mailing Address - Fax:
Practice Address - Street 1:23832 SOUTHFIELD RD STE 2
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-8001
Practice Address - Country:US
Practice Address - Phone:248-557-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist