Provider Demographics
NPI:1124483789
Name:PATEL, SHAILESH (PHARMACIST)
Entity type:Individual
Prefix:
First Name:SHAILESH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2718
Mailing Address - Country:US
Mailing Address - Phone:817-332-6386
Mailing Address - Fax:
Practice Address - Street 1:3409 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2718
Practice Address - Country:US
Practice Address - Phone:817-332-6386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2020-09-28
Deactivation Date:2020-09-12
Deactivation Code:
Reactivation Date:2020-09-25
Provider Licenses
StateLicense IDTaxonomies
TX37490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist