Provider Demographics
NPI:1629399258
Name:PATEL, SHITAL JAYESH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHITAL
Middle Name:JAYESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 VAN BUREN BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-8014
Mailing Address - Country:US
Mailing Address - Phone:951-688-5155
Mailing Address - Fax:951-688-4421
Practice Address - Street 1:6150 VAN BUREN BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-8014
Practice Address - Country:US
Practice Address - Phone:951-688-5155
Practice Address - Fax:951-688-4421
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist