Healthcare Provider Details

I. General information

NPI: 1841121365
Provider Name (Legal Business Name): RAM PRAVIN PATEL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

5496 S HYDE PARK BLVD APT 502
CHICAGO IL
60615-5862
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-7110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051.307219
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: