Provider Demographics
NPI:1437750726
Name:MODY, VIDHI
Entity type:Individual
Prefix:
First Name:VIDHI
Middle Name:
Last Name:MODY
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 1:150 ROUTE 70 E
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1856
Mailing Address - Country:US
Mailing Address - Phone:856-988-1982
Mailing Address - Fax:
Practice Address - Street 1:150 ROUTE 70 E
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1856
Practice Address - Country:US
Practice Address - Phone:856-988-1982
Practice Address - Fax:856-988-1622
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03248600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist