Provider Demographics
NPI:1912343963
Name:PATEL, HETAL J (RPH)
Entity Type:Individual
Prefix:
First Name:HETAL
Middle Name:J
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 1:6 OLDE ORCHARD PARK
Mailing Address - Street 2:APT 617
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6968
Mailing Address - Country:US
Mailing Address - Phone:810-730-6828
Mailing Address - Fax:802-864-6080
Practice Address - Street 1:6 OLDE ORCHARD PARK
Practice Address - Street 2:APT 617
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6968
Practice Address - Country:US
Practice Address - Phone:810-730-6828
Practice Address - Fax:802-864-6080
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0003743183500000X
MI5302035457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302035457OtherMICHIGAN BOARD OF PHARMACY PHARMACIST LICENSE NO.
VT033.0003743OtherVERMONT BOARD OF PHARMACY PHARMACIST LICENSE NO.