Provider Demographics
NPI:1396331146
Name:PATEL, KAMLESH (RPH)
Entity type:Individual
Prefix:
First Name:KAMLESH
Middle Name:
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 1:1002 S BUSSE RD
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-4570
Mailing Address - Country:US
Mailing Address - Phone:847-871-6291
Mailing Address - Fax:
Practice Address - Street 1:1002 S BUSSE RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-4570
Practice Address - Country:US
Practice Address - Phone:847-871-6291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-032992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1740384684OtherNPI