MEDICARE: MAYA PATEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051-040256	IL

General Provider Information

NPI Number	:	1063780286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA PATEL

Provider Business Mailing Address
First Line	:	2040 GLEN ELLYN ROAD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139
Country	:	US
Telephone Number	:	630-539-6597
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 GLEN ELLYN RD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-2266
Country	:	US
Telephone Number	:	630-539-6597
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2011
Last Update Date	:	12/02/2011

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