Provider Demographics
NPI:1255766465
Name:PATEL, HARSHAL BHANUPRASAD (RPH)
Entity type:Individual
Prefix:
First Name:HARSHAL
Middle Name:BHANUPRASAD
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 1:475 W MAIN ST # 252
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2244
Mailing Address - Country:US
Mailing Address - Phone:760-351-3007
Mailing Address - Fax:
Practice Address - Street 1:475 W MAIN ST # 252
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2244
Practice Address - Country:US
Practice Address - Phone:760-351-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist