MEDICARE: PRIYAL 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RPH-0014900	OR
2	183500000X	Pharmacist	RPH 0014900	OR

General Provider Information

NPI Number	:	1255701876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRIYAL PATEL

Provider Business Mailing Address
First Line	:	2790 BROADWAY AVE
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-2216
Country	:	US
Telephone Number	:	541-449-9190
Fax Number	:

Provider Business Practice Location Address
First Line	:	2790 BROADWAY AVE
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-2216
Country	:	US
Telephone Number	:	541-449-9190
Fax Number	:

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

Provider Enumeration Date	:	09/25/2015
Last Update Date	:	02/04/2021

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Directions to “ PRIYAL PATEL ” Practice Location

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