Provider Demographics
NPI:1063937977
Name:PATEL, RUDRABEN P
Entity type:Individual
Prefix:MISS
First Name:RUDRABEN
Middle Name:P
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 WESTFIELD CT APT 504
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5077
Mailing Address - Country:US
Mailing Address - Phone:931-261-7676
Mailing Address - Fax:
Practice Address - Street 1:1051 S RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-4303
Practice Address - Country:US
Practice Address - Phone:931-645-2494
Practice Address - Fax:931-919-1218
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000060094183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician