Provider Demographics
NPI:1558974188
Name:PATEL, JAIMIN
Entity Type:Individual
Prefix:
First Name:JAIMIN
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 N LAS VEGAS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-5803
Mailing Address - Country:US
Mailing Address - Phone:702-649-1415
Mailing Address - Fax:702-649-1447
Practice Address - Street 1:2280 N LAS VEGAS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-5803
Practice Address - Country:US
Practice Address - Phone:702-649-1415
Practice Address - Fax:702-649-1447
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist