Provider Demographics
NPI:1760751473
Name:PATEL, MONA G (PHARMD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:G
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11160 VEIRS MILL RD
Mailing Address - Street 2:T-1415
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11160 VEIRS MILL RD
Practice Address - Street 2:T-1415
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-2538
Practice Address - Country:US
Practice Address - Phone:301-946-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-26
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist