Provider Demographics
NPI:1841732955
Name:PATEL, JITEN VIJAY (PHARMD)
Entity type:Individual
Prefix:
First Name:JITEN
Middle Name:VIJAY
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 1:2081 S SANDERS CT
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-2097
Mailing Address - Country:US
Mailing Address - Phone:562-652-8223
Mailing Address - Fax:
Practice Address - Street 1:2081 S SANDERS CT
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-2097
Practice Address - Country:US
Practice Address - Phone:562-652-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist