Provider Demographics
NPI:1356068100
Name:PATEL, SHIRISHCHANDRA GOVINDBHAI (RPH)
Entity type:Individual
Prefix:
First Name:SHIRISHCHANDRA
Middle Name:GOVINDBHAI
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 1:15940 QUANTICO RD STE 100
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1300
Mailing Address - Country:US
Mailing Address - Phone:760-946-1414
Mailing Address - Fax:
Practice Address - Street 1:15940 QUANTICO RD STE 100
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1300
Practice Address - Country:US
Practice Address - Phone:760-946-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51847OtherCALIFORNIA STATE BOARD OF PHARMACY