Provider Demographics
NPI:1609144609
Name:PATEL, DILESH (PHARM D)
Entity Type:Individual
Prefix:
First Name:DILESH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 HACKS CROSS RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-4471
Mailing Address - Country:US
Mailing Address - Phone:662-890-8644
Mailing Address - Fax:662-890-8646
Practice Address - Street 1:7030 HACKS CROSS RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-4471
Practice Address - Country:US
Practice Address - Phone:662-890-8644
Practice Address - Fax:662-890-8646
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09225183500000X
TN10911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist