Provider Demographics
NPI:1457331316
Name:PATEL, NIMISH CHANDRAKANT (RPH)
Entity Type:Individual
Prefix:
First Name:NIMISH
Middle Name:CHANDRAKANT
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 1:4681 SAVANNAH DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3899
Mailing Address - Country:US
Mailing Address - Phone:507-536-4112
Mailing Address - Fax:
Practice Address - Street 1:125 18TH ST SE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-4001
Practice Address - Country:US
Practice Address - Phone:507-451-8326
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117672-6183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist