Provider Demographics
NPI:1750987145
Name:PATEL, BHUPESH J (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:BHUPESH
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CITATION CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-6606
Mailing Address - Country:US
Mailing Address - Phone:540-842-9404
Mailing Address - Fax:
Practice Address - Street 1:10001 SOUTHPOINT PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-2700
Practice Address - Country:US
Practice Address - Phone:540-846-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA226290553OtherPHARMACIST