Provider Demographics
NPI:1154620011
Name:PATEL, ANNIE SHINN (PHARMD/PHD)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:SHINN
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMD/PHD
Other - Prefix:
Other - First Name:HEEKYUNG
Other - Middle Name:
Other - Last Name:SHINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD/PHD
Mailing Address - Street 1:900 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-3743
Mailing Address - Country:US
Mailing Address - Phone:209-239-4175
Mailing Address - Fax:
Practice Address - Street 1:900 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-3743
Practice Address - Country:US
Practice Address - Phone:209-239-4175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist