Healthcare Provider Details

I. General information

NPI: 1457331316
Provider Name (Legal Business Name): NIMISH CHANDRAKANT PATEL R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 18TH ST SE
OWATONNA MN
55060-4001
US

IV. Provider business mailing address

4681 SAVANNAH DR NW
ROCHESTER MN
55901-3899
US

V. Phone/Fax

Practice location:
  • Phone: 507-451-8326
  • Fax:
Mailing address:
  • Phone: 507-536-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number117672-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: