Provider Demographics
NPI:1558015941
Name:PATEL, VISHAL (PHARMD, BCCCP)
Entity Type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD, BCCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10151 MEADOW WOODS LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1570 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1821
Practice Address - Country:US
Practice Address - Phone:208-888-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP89741835C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835C0205XPharmacy Service ProvidersPharmacistCritical CareGroup - Single Specialty