Provider Demographics
NPI:1770185621
Name:PATEL, PURVI N (RPH)
Entity Type:Individual
Prefix:
First Name:PURVI
Middle Name:N
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 1:101 HIGHWAY 47 E
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-3100
Mailing Address - Country:US
Mailing Address - Phone:636-462-6366
Mailing Address - Fax:636-462-6377
Practice Address - Street 1:101 HIGHWAY 47 E
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-3100
Practice Address - Country:US
Practice Address - Phone:636-462-6366
Practice Address - Fax:636-462-6377
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006029415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist