Provider Demographics
NPI:1407445018
Name:PATEL, HARDIK CHANDRAKANT (LICENSED PHARMACIST)
Entity Type:Individual
Prefix:
First Name:HARDIK
Middle Name:CHANDRAKANT
Last Name:PATEL
Suffix:
Gender:M
Credentials:LICENSED PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 NE JOHNSON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4139
Mailing Address - Country:US
Mailing Address - Phone:817-789-4099
Mailing Address - Fax:800-616-4641
Practice Address - Street 1:113 NE JOHNSON AVE STE 300
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4139
Practice Address - Country:US
Practice Address - Phone:817-789-4099
Practice Address - Fax:800-616-4641
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX681133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy