Provider Demographics
NPI:1578822763
Name:PATEL, CHAITALI
Entity Type:Individual
Prefix:
First Name:CHAITALI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17502 LA CANTERA PKWY
Mailing Address - Street 2:T-2187
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-8202
Mailing Address - Country:US
Mailing Address - Phone:210-247-0114
Mailing Address - Fax:
Practice Address - Street 1:17502 LA CANTERA PKWY
Practice Address - Street 2:T-2187
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-8202
Practice Address - Country:US
Practice Address - Phone:210-247-0114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist