Provider Demographics
NPI:1881961456
Name:PATEL, VISHAL S
Entity type:Individual
Prefix:
First Name:VISHAL
Middle Name:S
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 1:4530 BRANDT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8445
Mailing Address - Country:US
Mailing Address - Phone:336-510-8368
Mailing Address - Fax:
Practice Address - Street 1:930 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405
Practice Address - Country:US
Practice Address - Phone:336-763-7282
Practice Address - Fax:336-937-8259
Is Sole Proprietor?:No
Enumeration Date:2011-11-25
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist