Healthcare Provider Details

I. General information

NPI: 1407225139
Provider Name (Legal Business Name): MR. BHADRAKSH P PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S CENTRAL VALLEY HWY
SHAFTER CA
93263-2790
US

IV. Provider business mailing address

11713 COVENT GARDENS DR
BAKERSFIELD CA
93311-9241
US

V. Phone/Fax

Practice location:
  • Phone: 800-300-6664
  • Fax:
Mailing address:
  • Phone: 661-703-0486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 47228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: