Healthcare Provider Details

I. General information

NPI: 1225372337
Provider Name (Legal Business Name): PRACHI PATEL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE
HINES IL
60141-3030
US

IV. Provider business mailing address

5000 S 5TH AVE
HINES IL
60141-3030
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-4092
  • Fax: 708-202-4185
Mailing address:
  • Phone: 708-202-4092
  • Fax: 708-202-4185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16720-40
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number051296124
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: