Provider Demographics
NPI:1942583448
Name:PATEL, PAYAL VISHNUBHAI
Entity Type:Individual
Prefix:
First Name:PAYAL
Middle Name:VISHNUBHAI
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:G-4010 FENTON ROAD
Mailing Address - Street 2:WALGREENS - 7501
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-7823
Mailing Address - Country:US
Mailing Address - Phone:810-424-0224
Mailing Address - Fax:810-424-0618
Practice Address - Street 1:G-4010 FENTON RAOD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-424-0224
Practice Address - Fax:810-424-0618
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist