Provider Demographics
NPI:1053605444
Name:PATEL, BHAVIKKUMAR KIRITKUMAR (PHARMD)
Entity type:Individual
Prefix:
First Name:BHAVIKKUMAR
Middle Name:KIRITKUMAR
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 1:1601 N IMPERIAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-1399
Mailing Address - Country:US
Mailing Address - Phone:760-592-4650
Mailing Address - Fax:760-592-4667
Practice Address - Street 1:1601 N IMPERIAL AVE STE B
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-1399
Practice Address - Country:US
Practice Address - Phone:760-592-4650
Practice Address - Fax:760-592-4667
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist