Provider Demographics
NPI:1346530391
Name:PATWARDHAN, VINAY ANIL
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:ANIL
Last Name:PATWARDHAN
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 1:15226 PRESCOTT HILL AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2687
Mailing Address - Country:US
Mailing Address - Phone:704-752-5101
Mailing Address - Fax:
Practice Address - Street 1:8520 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-5803
Practice Address - Country:US
Practice Address - Phone:704-553-8039
Practice Address - Fax:704-553-1510
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist