Provider Demographics
NPI:1134618739
Name:PATEL, PIYUSH N
Entity type:Individual
Prefix:
First Name:PIYUSH
Middle Name:N
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W PIERSON RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48505-3348
Mailing Address - Country:US
Mailing Address - Phone:810-785-7770
Mailing Address - Fax:810-785-7700
Practice Address - Street 1:118 W PIERSON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-3348
Practice Address - Country:US
Practice Address - Phone:810-785-7770
Practice Address - Fax:810-785-7700
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37406183500000X
MI5302037773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist