=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043495047
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KALPANA PATEL B PHARM INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2008
-----------------------------------------------------
Last Update Date | 10/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3805 SAN DIMAS ST STE A
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93301-5724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-325-7979
-----------------------------------------------------
Fax | 661-325-8181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3805 SAN DIMAS ST STE A
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93301-5724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-325-7979
-----------------------------------------------------
Fax | 661-325-8181
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KALPANA PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 661-319-6939
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 48922
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------