Provider Demographics
NPI:1255756201
Name:PATEL, VAISHALI ALPESH
Entity type:Individual
Prefix:
First Name:VAISHALI
Middle Name:ALPESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3679 E LINDA LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4340
Mailing Address - Country:US
Mailing Address - Phone:480-678-4506
Mailing Address - Fax:
Practice Address - Street 1:4505 E MCKELLIPS RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2523
Practice Address - Country:US
Practice Address - Phone:480-641-6740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014827183500000X
CA59394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBW8620521OtherSTORE DEA #