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General NPI Number Information
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NPI Number | 1063652121
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Entity Type | Organization
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Legal Business Name | KOKILA PATEL
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 04/28/2009
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Provider Practice Location Address
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Address Line | 11228 BRIDGEPORT WAY SW SUITE B
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City | LAKEWOOD
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State | WA
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Zip | 98499-3003
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Country | US
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Telephone | 253-302-4559
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Fax | 253-302-4563
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Provider Business Mailing Address
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Address Line | 11228 BRIDGEPORT WAY SW SUITE B
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City | LAKEWOOD
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State | WA
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Zip | 98499-3003
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUNIL PATEL
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Credential |
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Telephone | 425-785-6610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 60078627
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License Number State | WA
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