Provider Demographics
NPI:1326803719
Name:PATEL, SHAILESH
Entity Type:Individual
Prefix:
First Name:SHAILESH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SHAILESH
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1724 S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:LOCKHART
Mailing Address - State:TX
Mailing Address - Zip Code:78644-3937
Mailing Address - Country:US
Mailing Address - Phone:512-398-2288
Mailing Address - Fax:
Practice Address - Street 1:1724 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-3937
Practice Address - Country:US
Practice Address - Phone:512-398-2288
Practice Address - Fax:512-398-2289
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist