Healthcare Provider Details

I. General information

NPI: 1306123823
Provider Name (Legal Business Name): MUKESH PATEL PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12471 LIMONITE AVE T-1961
EASTVALE CA
91752-2457
US

IV. Provider business mailing address

12471 LIMONITE AVE T-1961
EASTVALE CA
91752-2457
US

V. Phone/Fax

Practice location:
  • Phone: 951-256-5262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: