Healthcare Provider Details

I. General information

NPI: 1871813220
Provider Name (Legal Business Name): PRAJAY PATEL R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6075 MAGNOLIA AVE
RIVERSIDE CA
92506-2525
US

IV. Provider business mailing address

6969 MONTEGO ST
CHINO CA
91710-8125
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-0177
  • Fax:
Mailing address:
  • Phone: 714-225-2366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: