Provider Demographics
NPI:1679311435
Name:PATEL, VANDAN PRADIPKUMAR
Entity type:Individual
Prefix:
First Name:VANDAN
Middle Name:PRADIPKUMAR
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 1:6065 GRACE ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1369
Mailing Address - Country:US
Mailing Address - Phone:334-207-6866
Mailing Address - Fax:
Practice Address - Street 1:6065 GRACE ST
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1369
Practice Address - Country:US
Practice Address - Phone:334-207-6866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist