Healthcare Provider Details

I. General information

NPI: 1447745856
Provider Name (Legal Business Name): JAIMINI SANDIP PATEL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

IV. Provider business mailing address

47415 PARKGATE CT
CANTON MI
48188-4706
US

V. Phone/Fax

Practice location:
  • Phone: 734-883-0183
  • Fax:
Mailing address:
  • Phone: 734-883-0183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number5302041607
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: