Provider Demographics
NPI:1093119844
Name:PATEL, KIRANKUMAR KANAIYALAL (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIRANKUMAR
Middle Name:KANAIYALAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19110 VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1101
Mailing Address - Country:US
Mailing Address - Phone:866-202-9552
Mailing Address - Fax:866-794-4844
Practice Address - Street 1:19110 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1101
Practice Address - Country:US
Practice Address - Phone:866-202-9552
Practice Address - Fax:866-794-4844
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA695381835P0018X
MSP132681835P0018X
KY0174561835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist