Provider Demographics
NPI:1548769086
Name:PATEL, MANALI (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:MANALI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13782 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8833
Mailing Address - Country:US
Mailing Address - Phone:515-313-3063
Mailing Address - Fax:
Practice Address - Street 1:13782 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8833
Practice Address - Country:US
Practice Address - Phone:515-313-3063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-11
Last Update Date:2018-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist