Provider Demographics
NPI:1811406796
Name:PATEL, PARTHIV JAY
Entity Type:Individual
Prefix:MR
First Name:PARTHIV
Middle Name:JAY
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12209 BAYSWATER CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5393
Mailing Address - Country:US
Mailing Address - Phone:804-360-8945
Mailing Address - Fax:
Practice Address - Street 1:11400 W BROAD ST RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-5821
Practice Address - Country:US
Practice Address - Phone:804-360-9782
Practice Address - Fax:804-360-9784
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-23
Last Update Date:2017-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14798183500000X
CA50075183500000X
VA0202205601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist