Healthcare Provider Details

I. General information

NPI: 1518567288
Provider Name (Legal Business Name): MRS. KALPNABEN MUKESH PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15311 KWANZAN CT
NORTH POTOMAC MD
20878-4702
US

IV. Provider business mailing address

15311 KWANZAN CT
NORTH POTOMAC MD
20878-4702
US

V. Phone/Fax

Practice location:
  • Phone: 301-926-8220
  • Fax:
Mailing address:
  • Phone: 301-926-8220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11908
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number11908
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: