Provider Demographics
NPI:1326328808
Name:PATEL, KUNAL B (PHARMD)
Entity Type:Individual
Prefix:
First Name:KUNAL
Middle Name:B
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 W FITCH AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1012
Mailing Address - Country:US
Mailing Address - Phone:847-982-9562
Mailing Address - Fax:
Practice Address - Street 1:1858 E OAKTON ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-2112
Practice Address - Country:US
Practice Address - Phone:847-299-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.294137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist