Provider Demographics
NPI:1962278390
Name:PATEL, ANJALI DILIPBHAI
Entity type:Individual
Prefix:
First Name:ANJALI
Middle Name:DILIPBHAI
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 1:345 SW HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5364
Mailing Address - Country:US
Mailing Address - Phone:503-327-0234
Mailing Address - Fax:
Practice Address - Street 1:345 SW HARRISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5364
Practice Address - Country:US
Practice Address - Phone:503-327-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85212183500000X
OR0019831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist