Healthcare Provider Details

I. General information

NPI: 1750353660
Provider Name (Legal Business Name): RAJNI C PATEL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 E FULTON ST
GRAND RAPIDS MI
49503-3853
US

IV. Provider business mailing address

1677 WALKER AVE NW
GRAND RAPIDS MI
49504-2650
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-9422
  • Fax: 616-774-9380
Mailing address:
  • Phone: 616-735-1597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302031253
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: