Provider Demographics
NPI:1871867648
Name:PATEL, CHANDRAKANT SHIVARAMBHAI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:CHANDRAKANT
Middle Name:SHIVARAMBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 TUSCANY LN SW
Mailing Address - Street 2:APT # 321
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7873
Mailing Address - Country:US
Mailing Address - Phone:360-489-9603
Mailing Address - Fax:
Practice Address - Street 1:301 E WALLACE KNEELAND BLVD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2985
Practice Address - Country:US
Practice Address - Phone:360-432-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-26
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60066304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist