Healthcare Provider Details

I. General information

NPI: 1730833294
Provider Name (Legal Business Name): TEJAS PATEL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 N BUTTE ST
WILLOWS CA
95988-2804
US

IV. Provider business mailing address

226 N BUTTE ST
WILLOWS CA
95988-2804
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-7744
  • Fax:
Mailing address:
  • Phone: 530-934-7744
  • Fax: 530-934-8450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: