Healthcare Provider Details

I. General information

NPI: 1932895133
Provider Name (Legal Business Name): PRACHI VIKAS PATEL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 06/02/2024
Certification Date: 06/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 W BURLEIGH ST
WAUWATOSA WI
53222-3211
US

IV. Provider business mailing address

234 N BROADWAY UNIT 117
MILWAUKEE WI
53202-5827
US

V. Phone/Fax

Practice location:
  • Phone: 414-290-0910
  • Fax:
Mailing address:
  • Phone: 847-477-2831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22105-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: