Provider Demographics
NPI:1962844258
Name:PATEL, KINJALBEN PRAKASHKUMAR (PHARMD)
Entity Type:Individual
Prefix:
First Name:KINJALBEN
Middle Name:PRAKASHKUMAR
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 1:1146 STALLINGS RD
Mailing Address - Street 2:
Mailing Address - City:STALLINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-4975
Mailing Address - Country:US
Mailing Address - Phone:704-776-5871
Mailing Address - Fax:
Practice Address - Street 1:1402 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5160
Practice Address - Country:US
Practice Address - Phone:704-776-4371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist