Provider Demographics
NPI:1659850923
Name:PATEL, HITESHKUMAR PRAVINCHANDRA
Entity Type:Individual
Prefix:
First Name:HITESHKUMAR
Middle Name:PRAVINCHANDRA
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 1:18411 N CAVE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-1099
Mailing Address - Country:US
Mailing Address - Phone:602-494-7424
Mailing Address - Fax:602-494-7520
Practice Address - Street 1:18411 N CAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1099
Practice Address - Country:US
Practice Address - Phone:602-494-7424
Practice Address - Fax:602-494-7520
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist