Provider Demographics
NPI:1053669259
Name:PATEL, VIKAS
Entity Type:Individual
Prefix:MR
First Name:VIKAS
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 1:880 HEBRON PKWY STE 170
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057
Mailing Address - Country:US
Mailing Address - Phone:469-968-5222
Mailing Address - Fax:
Practice Address - Street 1:880 HEBRON PKWY STE 170
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057
Practice Address - Country:US
Practice Address - Phone:469-968-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-17
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41161183500000X
FLPS57252183500000X
MI5302031493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist