Provider Demographics
NPI:1962977348
Name:PATEL, HASAMUKH FULABHAI
Entity type:Individual
Prefix:
First Name:HASAMUKH
Middle Name:FULABHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 W 203RD ST STE 108
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1184
Mailing Address - Country:US
Mailing Address - Phone:708-747-7283
Mailing Address - Fax:708-503-2372
Practice Address - Street 1:3800 W 203RD ST STE 108
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1184
Practice Address - Country:US
Practice Address - Phone:708-747-7283
Practice Address - Fax:708-503-2372
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051031309183500000X
IL051-031309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist