Provider Demographics
NPI:1417311929
Name:PATEL, YAGNESH V (R PH)
Entity Type:Individual
Prefix:MR
First Name:YAGNESH
Middle Name:V
Last Name:PATEL
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 ROYAL TROON CT
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-8714
Mailing Address - Country:US
Mailing Address - Phone:630-777-2254
Mailing Address - Fax:847-264-7300
Practice Address - Street 1:1780 WALL ST
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-5790
Practice Address - Country:US
Practice Address - Phone:847-264-7100
Practice Address - Fax:847-264-7300
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051285899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051285899OtherPHARMACY LICENSE NUMNER