Provider Demographics
NPI:1215059639
Name:PATEL, KUNAL JAYENDRA (RPH)
Entity type:Individual
Prefix:MR
First Name:KUNAL
Middle Name:JAYENDRA
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WHITE TAIL RUN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-7238
Mailing Address - Country:US
Mailing Address - Phone:270-605-0738
Mailing Address - Fax:
Practice Address - Street 1:1250 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3525
Practice Address - Country:US
Practice Address - Phone:606-676-0485
Practice Address - Fax:606-676-9625
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist