Healthcare Provider Details

I. General information

NPI: 1952612780
Provider Name (Legal Business Name): SUNIL K PATEL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10631 TIERRASANTA BLVD
SAN DIEGO CA
92124-2605
US

IV. Provider business mailing address

13660 WHITEWOOD CYN
POWAY CA
92064-1351
US

V. Phone/Fax

Practice location:
  • Phone: 858-576-0972
  • Fax: 858-576-0035
Mailing address:
  • Phone: 858-842-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: