Provider Demographics
NPI:1053718510
Name:PATEL, DHAVAL H (RPH)
Entity type:Individual
Prefix:
First Name:DHAVAL
Middle Name:H
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S MORRIS AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7555
Mailing Address - Country:US
Mailing Address - Phone:309-533-8141
Mailing Address - Fax:309-661-8619
Practice Address - Street 1:2001 S MORRIS AVE
Practice Address - Street 2:16
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-7293
Practice Address - Country:US
Practice Address - Phone:309-533-8141
Practice Address - Fax:309-661-8619
Is Sole Proprietor?:No
Enumeration Date:2014-11-28
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist