Provider Demographics
NPI:1912550500
Name:PATEL, KHUSHBU VIPIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KHUSHBU
Middle Name:VIPIN
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 INDIGO ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:HANAHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29410-8576
Mailing Address - Country:US
Mailing Address - Phone:609-475-2917
Mailing Address - Fax:
Practice Address - Street 1:2070 SAM RITTENBERG BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4605
Practice Address - Country:US
Practice Address - Phone:843-766-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist