Provider Demographics
NPI:1164626255
Name:PATEL, DIVYESH KISHORKUMAR (MS, RPH)
Entity Type:Individual
Prefix:
First Name:DIVYESH
Middle Name:KISHORKUMAR
Last Name:PATEL
Suffix:
Gender:M
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10409 WAXHAW MANOR DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-4000
Mailing Address - Country:US
Mailing Address - Phone:551-208-3080
Mailing Address - Fax:
Practice Address - Street 1:2505 LINCOLNTON HWY
Practice Address - Street 2:
Practice Address - City:CHERRYVILLE
Practice Address - State:NC
Practice Address - Zip Code:28021-8346
Practice Address - Country:US
Practice Address - Phone:704-435-4331
Practice Address - Fax:704-435-4331
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist