Provider Demographics
NPI:1750353660
Name:PATEL, RAJNI C (RPH)
Entity type:Individual
Prefix:MR
First Name:RAJNI
Middle Name:C
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1677 WALKER AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-2650
Mailing Address - Country:US
Mailing Address - Phone:616-735-1597
Mailing Address - Fax:
Practice Address - Street 1:1415 E FULTON ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3853
Practice Address - Country:US
Practice Address - Phone:616-774-9422
Practice Address - Fax:616-774-9380
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302031253OtherREGISTERED PHARMACIST LI