Healthcare Provider Details

I. General information

NPI: 1538769906
Provider Name (Legal Business Name): PRATIK PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 SANDHILL RD
OREM UT
84058-7307
US

IV. Provider business mailing address

302 S 740 E UNIT C103
AMERICAN FORK UT
84003-3944
US

V. Phone/Fax

Practice location:
  • Phone: 801-221-0700
  • Fax:
Mailing address:
  • Phone: 551-666-0214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number87772301701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: