Healthcare Provider Details

I. General information

NPI: 1275776494
Provider Name (Legal Business Name): ASHVIN S PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37355 8 MILE RD
LIVONIA MI
48152-1148
US

IV. Provider business mailing address

49077 WOODSON WAY
CANTON MI
48187-6673
US

V. Phone/Fax

Practice location:
  • Phone: 248-474-8657
  • Fax: 248-474-2872
Mailing address:
  • Phone: 734-981-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302035212
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: