Provider Demographics
NPI:1285329946
Name:PATEL, MAULIK MITUL (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MAULIK
Middle Name:MITUL
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 CASPER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-2631
Mailing Address - Country:US
Mailing Address - Phone:631-398-7678
Mailing Address - Fax:
Practice Address - Street 1:9401 SOUTHERN PINE BLVD STE J
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5596
Practice Address - Country:US
Practice Address - Phone:704-367-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0333501835N0905X
SC434341835N0905X
NC313221835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear