Provider Demographics
NPI:1841512258
Name:PATEL, SANJAY R (RPH)
Entity type:Individual
Prefix:
First Name:SANJAY
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15704 AGINCOURT DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5849
Mailing Address - Country:US
Mailing Address - Phone:704-451-5051
Mailing Address - Fax:704-510-4311
Practice Address - Street 1:9740B UNIVERSITY CITY BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3608
Practice Address - Country:US
Practice Address - Phone:704-688-5330
Practice Address - Fax:704-510-4311
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0609860Medicaid