Provider Demographics
NPI:1477522696
Name:PATEL, PARESH (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:PARESH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-2204
Mailing Address - Country:US
Mailing Address - Phone:661-721-7979
Mailing Address - Fax:661-721-7999
Practice Address - Street 1:1228 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2204
Practice Address - Country:US
Practice Address - Phone:661-721-7979
Practice Address - Fax:661-721-7999
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2018-06-28
Deactivation Date:2018-06-20
Deactivation Code:
Reactivation Date:2018-06-28
Provider Licenses
StateLicense IDTaxonomies
CAPHY44751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA447810MedicaidCALIFORNIA MEDI-CAL