Provider Demographics
NPI:1902174436
Name:MEHTA, OMINDER (PHARM D)
Entity type:Individual
Prefix:MR
First Name:OMINDER
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
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 1:7929 LOWER SACRAMENTO RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3723
Mailing Address - Country:US
Mailing Address - Phone:209-609-9279
Mailing Address - Fax:
Practice Address - Street 1:7929 LOWER SACRAMENTO RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3723
Practice Address - Country:US
Practice Address - Phone:209-609-9279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist