Provider Demographics
NPI:1770608143
Name:PATEL, KIRT K (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIRT
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4945 FAIRWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-2814
Mailing Address - Country:US
Mailing Address - Phone:714-404-6974
Mailing Address - Fax:
Practice Address - Street 1:933 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2420
Practice Address - Country:US
Practice Address - Phone:714-404-6974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47248183500000X
NV11973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist