Provider Demographics
NPI:1619520285
Name:PATEL, SIDHARTH
Entity Type:Individual
Prefix:
First Name:SIDHARTH
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 1:4048 E TOLEDO ST UNIT 104
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0172
Mailing Address - Country:US
Mailing Address - Phone:480-353-0006
Mailing Address - Fax:
Practice Address - Street 1:2431 S HIGLEY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1100
Practice Address - Country:US
Practice Address - Phone:480-988-4326
Practice Address - Fax:480-988-7464
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist