Provider Demographics
NPI:1952537359
Name:PATEL, VIMAL (MS - PHARMACY)
Entity Type:Individual
Prefix:
First Name:VIMAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MS - PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1884 ROBINWOOD RD APT D
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1696
Mailing Address - Country:US
Mailing Address - Phone:704-772-0450
Mailing Address - Fax:
Practice Address - Street 1:915 W. TRADE STREET
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034
Practice Address - Country:US
Practice Address - Phone:704-922-7187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist