Provider Demographics
NPI:1225421506
Name:PATEL, MUKESH VIRJIBHAI
Entity Type:Individual
Prefix:
First Name:MUKESH
Middle Name:VIRJIBHAI
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 1:2275 GUS THOMASSON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-3002
Mailing Address - Country:US
Mailing Address - Phone:214-660-9729
Mailing Address - Fax:214-660-9756
Practice Address - Street 1:2275 GUS THOMASSON ROAD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-4407
Practice Address - Country:US
Practice Address - Phone:214-660-9729
Practice Address - Fax:214-660-9756
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist