Provider Demographics
NPI:1578530309
Name:PATEL, VIJAY M (RPH)
Entity Type:Individual
Prefix:MR
First Name:VIJAY
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 LA SALLE POINTE
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5112
Mailing Address - Country:US
Mailing Address - Phone:714-821-8959
Mailing Address - Fax:714-821-4261
Practice Address - Street 1:2727 LA SALLE POINTE
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5112
Practice Address - Country:US
Practice Address - Phone:714-821-8959
Practice Address - Fax:714-821-4261
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 47035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist