MEDICARE: MUKESH G PATEL RPH

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	45247	CA
2	183500000X	Pharmacist	PS31790	FL
3	183500000X	Pharmacist		IL

General Provider Information

NPI Number	:	1639357106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUKESH G PATEL RPH

Provider Business Mailing Address
First Line	:	3441 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4841
Country	:	US
Telephone Number	:	773-772-6731
Fax Number	:	773-772-7860

Provider Business Practice Location Address
First Line	:	3441 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4841
Country	:	US
Telephone Number	:	773-772-6731
Fax Number	:	773-772-7860

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

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	02/06/2008

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