Provider Demographics
NPI:1811704034
Name:PATEL, VIKAS MAHENDRAKUMAR
Entity type:Individual
Prefix:
First Name:VIKAS
Middle Name:MAHENDRAKUMAR
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8207 ELDERBERRY DR APT 12
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7088
Mailing Address - Country:US
Mailing Address - Phone:610-563-0505
Mailing Address - Fax:
Practice Address - Street 1:220 FOOTHILLS MALL DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-5516
Practice Address - Country:US
Practice Address - Phone:865-379-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist