Provider Demographics
NPI:1124652789
Name:PATEL, SUNNY DINESHKUMAR (PHARMACIST)
Entity type:Individual
Prefix:
First Name:SUNNY
Middle Name:DINESHKUMAR
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 1:1021 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4457
Mailing Address - Country:US
Mailing Address - Phone:262-567-9173
Mailing Address - Fax:262-567-3034
Practice Address - Street 1:1021 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4457
Practice Address - Country:US
Practice Address - Phone:262-567-9173
Practice Address - Fax:262-567-3034
Is Sole Proprietor?:No
Enumeration Date:2020-02-23
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18698-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist