Healthcare Provider Details

I. General information

NPI: 1245140813
Provider Name (Legal Business Name): KAVISHA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 W DIVISION ST
SAINT CLOUD MN
56301-3926
US

IV. Provider business mailing address

1921 7TH ST N APT 204
SAINT CLOUD MN
56303-3672
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-5366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number127518
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: