Provider Demographics
NPI:1134351224
Name:PATEL, KETANKUMAR MADHABHAI (BPHARM)
Entity type:Individual
Prefix:
First Name:KETANKUMAR
Middle Name:MADHABHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 NEWARK CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2510
Mailing Address - Country:US
Mailing Address - Phone:810-953-0362
Mailing Address - Fax:
Practice Address - Street 1:5370 E HILL RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8622
Practice Address - Country:US
Practice Address - Phone:810-694-4775
Practice Address - Fax:810-606-8423
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist