Provider Demographics
NPI:1912131491
Name:PATEL, PANKAJKUMAR RAMESHBHAI
Entity Type:Individual
Prefix:
First Name:PANKAJKUMAR
Middle Name:RAMESHBHAI
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 1:4365 NEWARK CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2510
Mailing Address - Country:US
Mailing Address - Phone:810-606-8456
Mailing Address - Fax:810-424-3565
Practice Address - Street 1:4365 NEWARK CIR
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2510
Practice Address - Country:US
Practice Address - Phone:810-606-8456
Practice Address - Fax:810-424-3565
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist