Healthcare Provider Details

I. General information

NPI: 1508134347
Provider Name (Legal Business Name): DULARI KETANKUMAR PATEL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 SYCAMORE DR
SIMI VALLEY CA
93065-2301
US

IV. Provider business mailing address

2417 SYCAMORE DR
SIMI VALLEY CA
93065-2301
US

V. Phone/Fax

Practice location:
  • Phone: 805-426-3722
  • Fax: 805-426-3728
Mailing address:
  • Phone: 805-426-3722
  • Fax: 805-426-3728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 55546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: