Healthcare Provider Details

I. General information

NPI: 1649750704
Provider Name (Legal Business Name): NIVA D PATEL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 TELEGRAPH AVE
BERKELEY CA
94704-3323
US

IV. Provider business mailing address

2655 TELEGRAPH AVE
BERKELEY CA
94704-3323
US

V. Phone/Fax

Practice location:
  • Phone: 978-809-9041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number76183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: