Provider Demographics
NPI:1326412131
Name:PATEL, BHAVESH RAMESHBHAI
Entity Type:Individual
Prefix:
First Name:BHAVESH
Middle Name:RAMESHBHAI
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 1:5222 MORNING DOVE WAY
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-8972
Mailing Address - Country:US
Mailing Address - Phone:443-519-8496
Mailing Address - Fax:
Practice Address - Street 1:1120 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-1418
Practice Address - Country:US
Practice Address - Phone:443-519-8496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0004802183500000X
MD23735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist