Healthcare Provider Details

I. General information

NPI: 1679803894
Provider Name (Legal Business Name): KAUSIK J PATEL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21632 N 35TH AVE
GLENDALE AZ
85308-2061
US

IV. Provider business mailing address

21632 N 35TH AVE
GLENDALE AZ
85308-2061
US

V. Phone/Fax

Practice location:
  • Phone: 623-582-9566
  • Fax: 623-582-2844
Mailing address:
  • Phone: 623-582-9566
  • Fax: 623-582-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number012683
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: