Healthcare Provider Details

I. General information

NPI: 1770114365
Provider Name (Legal Business Name): MANAN SHANABHAI PATEL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 WAVERLY PLZ
WAVERLY OH
45690-1222
US

IV. Provider business mailing address

3973 ZANZIBAR COURT
WINDSOR ONTARIO
N9G 0A4
CA

V. Phone/Fax

Practice location:
  • Phone: 519-980-9850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03443848
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: