Provider Demographics
NPI:1255437992
Name:PATEL, NISHA V (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NISHA
Middle Name:V
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 S SPRUCEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-4553
Mailing Address - Country:US
Mailing Address - Phone:847-258-4821
Mailing Address - Fax:
Practice Address - Street 1:1415 LAKE COOK RD
Practice Address - Street 2:MS #L449
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5213
Practice Address - Country:US
Practice Address - Phone:847-964-6484
Practice Address - Fax:847-964-6767
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist