Provider Demographics
NPI:1841626488
Name:PATEL, PRATIK D (RPH)
Entity type:Individual
Prefix:
First Name:PRATIK
Middle Name:D
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 VILLAGE GREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-5049
Mailing Address - Country:US
Mailing Address - Phone:615-364-3792
Mailing Address - Fax:
Practice Address - Street 1:423 VILLAGE GREEN BLVD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-5049
Practice Address - Country:US
Practice Address - Phone:615-364-3792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-14
Last Update Date:2013-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038512183500000X
GARPH026426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist