Provider Demographics
NPI:1700147246
Name:PATEL, MIRAL M
Entity Type:Individual
Prefix:
First Name:MIRAL
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 METRO CENTER DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190
Mailing Address - Country:US
Mailing Address - Phone:703-709-1623
Mailing Address - Fax:
Practice Address - Street 1:850 N RANDOLPH ST
Practice Address - Street 2:APT 1132
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1978
Practice Address - Country:US
Practice Address - Phone:540-664-6497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist