Provider Demographics
NPI:1710070396
Name:RAJNIKANT M PATEL
Entity Type:Organization
Organization Name:RAJNIKANT M PATEL
Other - Org Name:DUME PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJNIKANT
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:310-457-9707
Mailing Address - Street 1:29211 HEATHERCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4145
Mailing Address - Country:US
Mailing Address - Phone:310-457-9707
Mailing Address - Fax:
Practice Address - Street 1:29211 HEATHERCLIFF RD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4145
Practice Address - Country:US
Practice Address - Phone:310-457-9707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45225183500000X
CAPHY413093336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0512891OtherNABP#
CA1225250001Medicare ID - Type Unspecified