Provider Demographics
NPI:1932895133
Name:PATEL, PRACHI VIKAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:PRACHI
Middle Name:VIKAS
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 N BROADWAY UNIT 117
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-5827
Mailing Address - Country:US
Mailing Address - Phone:847-477-2831
Mailing Address - Fax:
Practice Address - Street 1:11111 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-3211
Practice Address - Country:US
Practice Address - Phone:414-290-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22105-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty