Provider Demographics
NPI:1568746329
Name:PATEL, PALLAVI R (PD)
Entity Type:Individual
Prefix:
First Name:PALLAVI
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8959 GLENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-5235
Mailing Address - Country:US
Mailing Address - Phone:225-387-5600
Mailing Address - Fax:225-387-5628
Practice Address - Street 1:3384 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5628
Practice Address - Country:US
Practice Address - Phone:225-387-5600
Practice Address - Fax:225-387-5628
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist