Provider Demographics
NPI:1750664900
Name:PATEL, PALLAVI S (RPH)
Entity Type:Individual
Prefix:
First Name:PALLAVI
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 N MILPITAS BLVD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-2734
Mailing Address - Country:US
Mailing Address - Phone:408-262-7774
Mailing Address - Fax:408-262-7931
Practice Address - Street 1:1833 N MILPITAS BLVD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-2734
Practice Address - Country:US
Practice Address - Phone:408-262-7774
Practice Address - Fax:408-262-7931
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist