Provider Demographics
NPI:1013057157
Name:PATEL, THAKORE N (RPH)
Entity type:Individual
Prefix:
First Name:THAKORE
Middle Name:N
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 W JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435
Mailing Address - Country:US
Mailing Address - Phone:815-730-3030
Mailing Address - Fax:815-725-9450
Practice Address - Street 1:2614 W. JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-730-3030
Practice Address - Fax:815-725-9450
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-0311061835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0750540001Medicare NSC