Provider Demographics
NPI:1114343522
Name:PATEL, VISHNU
Entity Type:Individual
Prefix:
First Name:VISHNU
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 1:674 LAS POSAS RD
Mailing Address - Street 2:1857 CALLE ALBERCA
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5716
Mailing Address - Country:US
Mailing Address - Phone:805-987-0643
Mailing Address - Fax:805-482-7804
Practice Address - Street 1:674 LAS POSAS RD
Practice Address - Street 2:1857 CALLE ALBERCA
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5716
Practice Address - Country:US
Practice Address - Phone:805-987-0643
Practice Address - Fax:805-482-7804
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist