Healthcare Provider Details

I. General information

NPI: 1720575608
Provider Name (Legal Business Name): SONAM PATEL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 PARKER CANYON ROAD
WALNUT CA
91789
US

IV. Provider business mailing address

1533 PARKER CANYON RD
WALNUT CA
91789-5334
US

V. Phone/Fax

Practice location:
  • Phone: 909-859-4207
  • Fax:
Mailing address:
  • Phone: 909-859-4207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number76615
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number76615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: