Provider Demographics
NPI:1215347307
Name:PATEL, SANDIP (PHARM D (PHARMACIST))
Entity type:Individual
Prefix:
First Name:SANDIP
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARM D (PHARMACIST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 W 7TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6932
Mailing Address - Country:US
Mailing Address - Phone:201-888-6845
Mailing Address - Fax:
Practice Address - Street 1:57701 TWENTYNINE PALMS HWY
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284
Practice Address - Country:US
Practice Address - Phone:201-888-6845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist