Provider Demographics
NPI:1053605998
Name:PATEL, BHAVIKA (PHARM D)
Entity type:Individual
Prefix:
First Name:BHAVIKA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 PHILADELPHIA ST
Mailing Address - Street 2:T-0258
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2481
Mailing Address - Country:US
Mailing Address - Phone:909-464-0063
Mailing Address - Fax:
Practice Address - Street 1:5555 PHILADELPHIA ST
Practice Address - Street 2:T-0258
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2481
Practice Address - Country:US
Practice Address - Phone:909-464-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist