Provider Demographics
NPI:1841573342
Name:PATEL, CHANDRABALA K (RPH)
Entity type:Individual
Prefix:MRS
First Name:CHANDRABALA
Middle Name:K
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 W BOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1752
Mailing Address - Country:US
Mailing Address - Phone:630-771-1494
Mailing Address - Fax:630-771-1542
Practice Address - Street 1:695 W BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBRROK
Practice Address - State:IL
Practice Address - Zip Code:60440-1742
Practice Address - Country:US
Practice Address - Phone:630-771-1494
Practice Address - Fax:630-771-1542
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-032985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist