Provider Demographics
NPI:1801182761
Name:PATEL, SMUTI C (RPH)
Entity Type:Individual
Prefix:
First Name:SMUTI
Middle Name:C
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 1:8900 HIGHWAY 7
Mailing Address - Street 2:T-2189
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3919
Mailing Address - Country:US
Mailing Address - Phone:952-935-8407
Mailing Address - Fax:
Practice Address - Street 1:8900 HIGHWAY 7
Practice Address - Street 2:T-2189
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3919
Practice Address - Country:US
Practice Address - Phone:952-935-8407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116152-4183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist