Provider Demographics
NPI:1669593794
Name:PATEL, KOMAL T (RPH)
Entity type:Individual
Prefix:MS
First Name:KOMAL
Middle Name:T
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 1:2620 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-3041
Mailing Address - Country:US
Mailing Address - Phone:408-241-0919
Mailing Address - Fax:408-241-1202
Practice Address - Street 1:2620 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-3041
Practice Address - Country:US
Practice Address - Phone:408-241-0919
Practice Address - Fax:408-241-1202
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist