Provider Demographics
NPI:1396175907
Name:PATEL, NIRAVKUMAR
Entity type:Individual
Prefix:
First Name:NIRAVKUMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 RAGETTA DRIVE APT 102
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016
Mailing Address - Country:US
Mailing Address - Phone:901-264-0462
Mailing Address - Fax:
Practice Address - Street 1:7910 REGATTA DR
Practice Address - Street 2:APT 102
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-1337
Practice Address - Country:US
Practice Address - Phone:901-264-0462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41416183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician