Provider Demographics
NPI:1750675120
Name:PATEL, VIRAL D (PHARMD, BCPS)
Entity type:Individual
Prefix:DR
First Name:VIRAL
Middle Name:D
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:DR
Other - First Name:VIC
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD, BCPS
Mailing Address - Street 1:4665 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1675
Mailing Address - Country:US
Mailing Address - Phone:707-863-4584
Mailing Address - Fax:
Practice Address - Street 1:4665 BUSINESS CENTER DR
Practice Address - Street 2:PHARMACY SERVICES DEPARTMENT
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1675
Practice Address - Country:US
Practice Address - Phone:707-863-4584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist