=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023721800
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KUNJ PATEL PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2022
-----------------------------------------------------
Last Update Date | 12/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 265 EASTCHESTER DR
-----------------------------------------------------
City | HIGH POINT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27262-7731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-869-6317
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4636 SKYVIEW TRL
-----------------------------------------------------
City | COLFAX
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27235-9824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 657-217-9540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 31724
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------