Provider Demographics
NPI:1972142917
Name:PATEL, RADHIKA NITIN
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:NITIN
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 1:15059 AVENIDA COMPADRES
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5164
Mailing Address - Country:US
Mailing Address - Phone:909-630-6218
Mailing Address - Fax:
Practice Address - Street 1:100 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3847
Practice Address - Country:US
Practice Address - Phone:909-982-8908
Practice Address - Fax:909-931-0090
Is Sole Proprietor?:No
Enumeration Date:2019-12-21
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist