Provider Demographics
NPI:1043623341
Name:PATEL, KRUNALKUMAR
Entity Type:Individual
Prefix:
First Name:KRUNALKUMAR
Middle Name:
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 1:4000 SCENIC RIVER LN APT 15G
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-7527
Mailing Address - Country:US
Mailing Address - Phone:973-572-9953
Mailing Address - Fax:661-872-5891
Practice Address - Street 1:2505 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-2919
Practice Address - Country:US
Practice Address - Phone:661-872-6272
Practice Address - Fax:661-872-5891
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist