Healthcare Provider Details

I. General information

NPI: 1538410394
Provider Name (Legal Business Name): DHARMENDRAKUMAR B PATEL PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N CAMBRIDGE ST
NINETY SIX SC
29666-1011
US

IV. Provider business mailing address

400 EMERALD RD N APT G-6
GREENWOOD SC
29646-3063
US

V. Phone/Fax

Practice location:
  • Phone: 864-543-2852
  • Fax: 864-543-2982
Mailing address:
  • Phone: 201-744-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13926
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: