Provider Demographics
NPI:1003402348
Name:PATEL, HEMANT PARSOTTAMDAS
Entity Type:Individual
Prefix:
First Name:HEMANT
Middle Name:PARSOTTAMDAS
Last Name:PATEL
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 1:12111 S LIL DICKENS LN
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-1651
Mailing Address - Country:US
Mailing Address - Phone:435-215-5864
Mailing Address - Fax:
Practice Address - Street 1:11328 S JORDAN GTWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4112
Practice Address - Country:US
Practice Address - Phone:435-215-5864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18408183500000X
UT7570395-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist