Provider Demographics
NPI:1740617018
Name:PATEL, RAM R (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:RAM
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 CREEDMOOR RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-9205
Mailing Address - Country:US
Mailing Address - Phone:919-847-7786
Mailing Address - Fax:919-847-7842
Practice Address - Street 1:11000 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-9205
Practice Address - Country:US
Practice Address - Phone:919-847-7786
Practice Address - Fax:919-847-7842
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0920256Medicaid