Provider Demographics
NPI:1194094565
Name:PATEL, NISHA S (PHARMD)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 PINNACLE PEAK
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-8248
Mailing Address - Country:US
Mailing Address - Phone:513-227-7431
Mailing Address - Fax:
Practice Address - Street 1:180 PINNACLE PEAK
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-8248
Practice Address - Country:US
Practice Address - Phone:513-227-7431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056470183500000X
MI5302039590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist