Provider Demographics
NPI:1396039582
Name:PATEL, RAVI (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAVI
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 1:1652 BEECHER RD
Mailing Address - Street 2:T2378
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-5602
Mailing Address - Country:US
Mailing Address - Phone:630-385-3201
Mailing Address - Fax:630-385-3201
Practice Address - Street 1:1652 BEECHER RD
Practice Address - Street 2:T2378
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-5602
Practice Address - Country:US
Practice Address - Phone:630-385-3201
Practice Address - Fax:630-385-3201
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051293248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist