Healthcare Provider Details

I. General information

NPI: 1871828046
Provider Name (Legal Business Name): MR. KANU A PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 W THUNDERBIRD RD
PHOENIX AZ
85053-5602
US

IV. Provider business mailing address

3421 W THUNDERBIRD RD
PHOENIX AZ
85053-5602
US

V. Phone/Fax

Practice location:
  • Phone: 602-375-0193
  • Fax: 602-862-0936
Mailing address:
  • Phone: 602-375-0193
  • Fax: 602-862-0936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS11173
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: