Provider Demographics
NPI:1366038531
Name:PATEL, MOHIT (PHARMD)
Entity Type:Individual
Prefix:
First Name:MOHIT
Middle Name:
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 1:6327 SHADOW RIDGE RUN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4290
Mailing Address - Country:US
Mailing Address - Phone:317-260-8800
Mailing Address - Fax:260-456-0577
Practice Address - Street 1:5802 S ANTHONY BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46816-3702
Practice Address - Country:US
Practice Address - Phone:260-456-5518
Practice Address - Fax:260-456-0577
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022931A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty