Provider Demographics
NPI:1154896223
Name:PATEL, APURVA I
Entity type:Individual
Prefix:
First Name:APURVA
Middle Name:
Last Name:PATEL
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 E HIGHLAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4682
Mailing Address - Country:US
Mailing Address - Phone:909-881-0088
Mailing Address - Fax:909-881-0055
Practice Address - Street 1:1535 E HIGHLAND AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4682
Practice Address - Country:US
Practice Address - Phone:909-881-0088
Practice Address - Fax:909-881-0055
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA82-1111439OtherEMPLOYER INDETIFICATION NUMBER
CA50027OtherSTATE BOARD OF PHARMACY