Healthcare Provider Details

I. General information

NPI: 1407146731
Provider Name (Legal Business Name): NEHAL PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3681 SHAWNEE RD
BRIDGMAN MI
49106-9713
US

IV. Provider business mailing address

3681 SHAWNEE RD
BRIDGMAN MI
49106-9713
US

V. Phone/Fax

Practice location:
  • Phone: 269-465-6777
  • Fax:
Mailing address:
  • Phone: 269-465-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberL1777533
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20517
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.294766
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: