MEDICARE: MUKESH PATEL PHARM D

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	66530	CA

General Provider Information

NPI Number	:	1306123823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUKESH PATEL PHARM D

Provider Business Mailing Address
First Line	:	12471 LIMONITE AVE
Second Line	:	T-1961
City	:	EASTVALE
State	:	CA
Zip	:	91752-2457
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12471 LIMONITE AVE
Second Line	:	T-1961
City	:	EASTVALE
State	:	CA
Zip	:	91752-2457
Country	:	US
Telephone Number	:	951-256-5262
Fax Number	:

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

Provider Enumeration Date	:	11/11/2011
Last Update Date	:	11/11/2011

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