Provider Demographics
NPI:1710217823
Name:PATEL, VIKRAM J (PHARMD)
Entity Type:Individual
Prefix:
First Name:VIKRAM
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16137 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3374
Mailing Address - Country:US
Mailing Address - Phone:909-429-4497
Mailing Address - Fax:909-429-4743
Practice Address - Street 1:16137 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3374
Practice Address - Country:US
Practice Address - Phone:909-429-4497
Practice Address - Fax:909-429-4743
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPHY518611835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist