Provider Demographics
NPI:1457567216
Name:PATEL, MONA C (RPH)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:C
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6045 WESTKNOLL DR APT 481
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-4995
Mailing Address - Country:US
Mailing Address - Phone:810-429-0260
Mailing Address - Fax:
Practice Address - Street 1:3717 FENTON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1554
Practice Address - Country:US
Practice Address - Phone:810-232-5118
Practice Address - Fax:810-424-3495
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist