Provider Demographics
NPI:1720619661
Name:PATEL, PURVI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:PURVI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7955 BRIDGE VLY
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-4350
Mailing Address - Country:US
Mailing Address - Phone:443-812-4049
Mailing Address - Fax:
Practice Address - Street 1:42934 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5034
Practice Address - Country:US
Practice Address - Phone:248-334-8817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18651183500000X
MI5302037323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist