Provider Demographics
NPI:1902181498
Name:PATEL, BEENA R
Entity Type:Individual
Prefix:MRS
First Name:BEENA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8710 N BEECH DALY RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-5001
Mailing Address - Country:US
Mailing Address - Phone:313-278-1000
Mailing Address - Fax:
Practice Address - Street 1:8710 N BEECH DALY RD # 8056
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-5001
Practice Address - Country:US
Practice Address - Phone:313-278-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035633183500000X
MI5315118570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist