Provider Demographics
NPI:1285795682
Name:MISTRY, AMEE D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMEE
Middle Name:D
Last Name:MISTRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WESTON ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453
Mailing Address - Country:US
Mailing Address - Phone:781-891-9525
Mailing Address - Fax:781-891-1649
Practice Address - Street 1:20 WESTON ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:781-891-9525
Practice Address - Fax:781-891-1649
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist