Provider Demographics
NPI:1992019046
Name:PATEL, DIPTI SHEETAL (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DIPTI
Middle Name:SHEETAL
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 SPRINGFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-2856
Mailing Address - Country:US
Mailing Address - Phone:714-697-7655
Mailing Address - Fax:
Practice Address - Street 1:16491 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-6723
Practice Address - Country:US
Practice Address - Phone:951-674-0309
Practice Address - Fax:951-674-0419
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist