Provider Demographics
NPI:1306123823
Name:PATEL, MUKESH (PHARM D)
Entity type:Individual
Prefix:
First Name:MUKESH
Middle Name:
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 1:12471 LIMONITE AVE
Mailing Address - Street 2:T-1961
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-2457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12471 LIMONITE AVE
Practice Address - Street 2:T-1961
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752-2457
Practice Address - Country:US
Practice Address - Phone:951-256-5262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist