Provider Demographics
NPI:1720546336
Name:PATEL, DIVYESHKUMAR
Entity Type:Individual
Prefix:
First Name:DIVYESHKUMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 GRANGE HALL DR APT 5206
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-1949
Mailing Address - Country:US
Mailing Address - Phone:201-238-7990
Mailing Address - Fax:
Practice Address - Street 1:900 GRANGE HALL DR APT 5206
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-1949
Practice Address - Country:US
Practice Address - Phone:201-238-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist