Provider Demographics
NPI:1083290175
Name:PATEL, RAJESH R (CPHT)
Entity Type:Individual
Prefix:
First Name:RAJESH
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 DRAWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-5250
Mailing Address - Country:US
Mailing Address - Phone:217-553-3965
Mailing Address - Fax:
Practice Address - Street 1:3401 FREEDOM DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6517
Practice Address - Country:US
Practice Address - Phone:217-793-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL49.116485183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician