Healthcare Provider Details

I. General information

NPI: 1750742011
Provider Name (Legal Business Name): PRASHANT PATEL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 TELEGRAPH AVE # 100
BERKELEY CA
94705-2060
US

IV. Provider business mailing address

2915 TELEGRAPH AVE # 100
BERKELEY CA
94705-2060
US

V. Phone/Fax

Practice location:
  • Phone: 510-570-2103
  • Fax:
Mailing address:
  • Phone: 510-570-2103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03334572
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: