Provider Demographics
NPI:1639776156
Name:PATEL, NITESH DILIPKUMAR
Entity Type:Individual
Prefix:
First Name:NITESH
Middle Name:DILIPKUMAR
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 1:4240 N PLACITA DE SANDRA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-7418
Mailing Address - Country:US
Mailing Address - Phone:845-544-8118
Mailing Address - Fax:
Practice Address - Street 1:825 E UNIVERSITY BLVD # 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5046
Practice Address - Country:US
Practice Address - Phone:520-624-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist