Healthcare Provider Details

I. General information

NPI: 1811406796
Provider Name (Legal Business Name): MR. PARTHIV JAY PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2017
Last Update Date: 09/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 W BROAD ST RD
GLEN ALLEN VA
23060-5821
US

IV. Provider business mailing address

12209 BAYSWATER CT
GLEN ALLEN VA
23059-5393
US

V. Phone/Fax

Practice location:
  • Phone: 804-360-9782
  • Fax: 804-360-9784
Mailing address:
  • Phone: 804-360-8945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14798
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50075
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202205601
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: