=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114814100
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRAPTI RAJESH PATEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2025
-----------------------------------------------------
Last Update Date | 06/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7520 W BLUEMOUND RD
-----------------------------------------------------
City | WAUWATOSA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53213-3546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-771-9146
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1160 BRENTWOOD CT
-----------------------------------------------------
City | HANOVER PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60133-2579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-478-5141
-----------------------------------------------------
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 | 22999-40
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------