Provider Demographics
NPI:1790651321
Name:PATEL, MEDHA DIPINKUMAR SHANTILAL
Entity type:Individual
Prefix:
First Name:MEDHA
Middle Name:DIPINKUMAR SHANTILAL
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 HANSTON CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5918
Mailing Address - Country:US
Mailing Address - Phone:832-847-1047
Mailing Address - Fax:
Practice Address - Street 1:2805 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2191
Practice Address - Country:US
Practice Address - Phone:713-578-6155
Practice Address - Fax:866-412-0213
Is Sole Proprietor?:No
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX303669183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician