Provider Demographics
NPI:1447583638
Name:PATEL, ASHISH J (RPH)
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 W WT HARRIS BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-8517
Mailing Address - Country:US
Mailing Address - Phone:704-598-8773
Mailing Address - Fax:704-598-8790
Practice Address - Street 1:3716 W WT HARRIS BLVD STE J
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-8517
Practice Address - Country:US
Practice Address - Phone:704-598-8773
Practice Address - Fax:704-598-8790
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-07
Last Update Date:2009-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0608611Medicaid