Provider Demographics
NPI:1083156913
Name:PATEL, PRIYANKA BHAVIKKUMAR (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:PRIYANKA
Middle Name:BHAVIKKUMAR
Last Name:PATEL
Suffix:
Gender:F
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 1:13048 ABING AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129
Mailing Address - Country:US
Mailing Address - Phone:858-240-7378
Mailing Address - Fax:858-240-0155
Practice Address - Street 1:9912 CARMEL MOUNTAIN RD STE E
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2808
Practice Address - Country:US
Practice Address - Phone:858-240-7378
Practice Address - Fax:858-240-0155
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist