Provider Demographics
NPI:1902039506
Name:PATEL, KAUSHAL R (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:KAUSHAL
Middle Name:R
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 1:2306 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4018
Mailing Address - Country:US
Mailing Address - Phone:517-574-5083
Mailing Address - Fax:517-574-5093
Practice Address - Street 1:2306 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4018
Practice Address - Country:US
Practice Address - Phone:517-574-5083
Practice Address - Fax:517-574-5093
Is Sole Proprietor?:No
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist