Provider Demographics
NPI:1417976952
Name:PATEL, JITESH A (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:JITESH
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 PINE COVE CT
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4999
Mailing Address - Country:US
Mailing Address - Phone:630-427-1768
Mailing Address - Fax:708-345-1011
Practice Address - Street 1:1516 MADISON ST
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-1824
Practice Address - Country:US
Practice Address - Phone:708-345-4658
Practice Address - Fax:708-345-1011
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364148087001Medicaid
IL4546170001Medicare ID - Type Unspecified