Provider Demographics
NPI:1992304539
Name:PATEL, VIRAJ M (PHARMD)
Entity type:Individual
Prefix:
First Name:VIRAJ
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 S JACKSON DR APT 109
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1991
Mailing Address - Country:US
Mailing Address - Phone:573-724-9236
Mailing Address - Fax:
Practice Address - Street 1:1525 E 23RD ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-1670
Practice Address - Country:US
Practice Address - Phone:816-836-9918
Practice Address - Fax:816-836-9919
Is Sole Proprietor?:No
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015027202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist