Provider Demographics
NPI:1528479243
Name:PATEL, JAGRUTI (RPH)
Entity type:Individual
Prefix:
First Name:JAGRUTI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4047 S VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6007
Mailing Address - Country:US
Mailing Address - Phone:775-825-2476
Mailing Address - Fax:775-825-5039
Practice Address - Street 1:4047 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6007
Practice Address - Country:US
Practice Address - Phone:775-825-2476
Practice Address - Fax:775-825-5039
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV13221OtherPHARMACIST LICENSE