Healthcare Provider Details

I. General information

NPI: 1922123850
Provider Name (Legal Business Name): MITA PATEL PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10675 W INDIAN SCHOOL RD
AVONDALE AZ
85392-5645
US

IV. Provider business mailing address

10675 W INDIAN SCHOOL RD
AVONDALE AZ
85392-5645
US

V. Phone/Fax

Practice location:
  • Phone: 623-772-0502
  • Fax: 623-872-4987
Mailing address:
  • Phone: 623-772-0502
  • Fax: 623-872-4987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-286284
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS026521
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051-286842
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS026521
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: