Provider Demographics
NPI:1265767701
Name:PATEL, PRASHANT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PRASHANT
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 POTTERS ROAD
Mailing Address - Street 2:WALGREENS 12350
Mailing Address - City:STALLINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28104
Mailing Address - Country:US
Mailing Address - Phone:704-821-0411
Mailing Address - Fax:704-821-0495
Practice Address - Street 1:5455 POTTERS ROAD
Practice Address - Street 2:WALGREENS 12350
Practice Address - City:STALLINGS
Practice Address - State:NC
Practice Address - Zip Code:28104
Practice Address - Country:US
Practice Address - Phone:704-821-0411
Practice Address - Fax:704-821-0495
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist