Healthcare Provider Details

I. General information

NPI: 1770737678
Provider Name (Legal Business Name): MRS. JESIKA S PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19400 W CATAWBA AVE
CORNELIUS NC
28031-4000
US

IV. Provider business mailing address

15704 AGINCOURT DR
HUNTERSVILLE NC
28078-5849
US

V. Phone/Fax

Practice location:
  • Phone: 704-892-9540
  • Fax:
Mailing address:
  • Phone: 704-895-6605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14302
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: