Provider Demographics
NPI:1295027043
Name:PATEL, SANJIV R (RPH)
Entity type:Individual
Prefix:MR
First Name:SANJIV
Middle Name:R
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 1:15090 IDLEWILD RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-3653
Mailing Address - Country:US
Mailing Address - Phone:704-882-4051
Mailing Address - Fax:704-882-0390
Practice Address - Street 1:15090 IDLEWILD RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-3653
Practice Address - Country:US
Practice Address - Phone:704-882-4051
Practice Address - Fax:704-882-0390
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18545183500000X
MA22485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist