Provider Demographics
NPI:1225311483
Name:PATEL, NISARG (RPH)
Entity Type:Individual
Prefix:MR
First Name:NISARG
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 W GRANT LINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-2597
Mailing Address - Country:US
Mailing Address - Phone:209-831-2050
Mailing Address - Fax:
Practice Address - Street 1:348 W GRANT LINE RD STE A
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2597
Practice Address - Country:US
Practice Address - Phone:209-831-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist