Provider Demographics
NPI:1649565904
Name:PATEL, ANKIT KANTI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANKIT
Middle Name:KANTI
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 W 33RD ST
Mailing Address - Street 2:TARGET PHARMACY STORE NUMBER T-2078
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1940 W 33RD ST
Practice Address - Street 2:TARGET PHARMACY STORE NUMBER T-2078
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6107
Practice Address - Country:US
Practice Address - Phone:773-843-3267
Practice Address - Fax:773-843-3261
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL410215170078Medicaid