Provider Demographics
NPI:1164892600
Name:DEAK, PATRICK LEWIS
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:LEWIS
Last Name:DEAK
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 1:2516 POTOMAC WAY
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-4770
Mailing Address - Country:US
Mailing Address - Phone:916-525-4920
Mailing Address - Fax:
Practice Address - Street 1:2516 POTOMAC WAY
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4770
Practice Address - Country:US
Practice Address - Phone:167-937-3099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-27
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist