Provider Demographics
NPI:1336749779
Name:PATEL, MANOJ NANALAL
Entity Type:Individual
Prefix:MR
First Name:MANOJ
Middle Name:NANALAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MANOJKUMAR
Other - Middle Name:NANALAL
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 S BOLINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2932
Mailing Address - Country:US
Mailing Address - Phone:630-739-4883
Mailing Address - Fax:630-739-4887
Practice Address - Street 1:200 S BOLINGBROOK DR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2932
Practice Address - Country:US
Practice Address - Phone:630-739-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist