Provider Demographics
NPI:1366043622
Name:PATEL, CHANDRAVADAN GORDHANBHAI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:CHANDRAVADAN
Middle Name:GORDHANBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:CHANDRAVADAN
Other - Middle Name:GORDHANBHAI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:6117 SYLLING DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6128
Mailing Address - Country:US
Mailing Address - Phone:361-232-0420
Mailing Address - Fax:
Practice Address - Street 1:1821 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78416-1398
Practice Address - Country:US
Practice Address - Phone:361-854-5804
Practice Address - Fax:361-855-5937
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist