Provider Demographics
NPI:1417549148
Name:PATEL, SANJAYKUMAR GHANSHYAMBHAI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SANJAYKUMAR
Middle Name:GHANSHYAMBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:SANJAY
Other - Middle Name:GHANSHYAMBHAI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1716 W MILHAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1230
Mailing Address - Country:US
Mailing Address - Phone:269-888-2300
Mailing Address - Fax:269-993-4749
Practice Address - Street 1:1716 W MILHAM AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1230
Practice Address - Country:US
Practice Address - Phone:269-888-2300
Practice Address - Fax:269-993-4749
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist