Provider Demographics
NPI:1629350731
Name:PATEL, SANJAY SHANTIBHAI (BS PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:SANJAY
Middle Name:SHANTIBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:BS PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1619
Mailing Address - Country:US
Mailing Address - Phone:510-742-9356
Mailing Address - Fax:510-742-9386
Practice Address - Street 1:2600 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1619
Practice Address - Country:US
Practice Address - Phone:510-742-9356
Practice Address - Fax:510-742-9386
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist