=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285788760
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHHITU PATEL RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 04/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1504 S BROADWAY
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93454-7214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-922-1747
-----------------------------------------------------
Fax | 805-925-6499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7440
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93456-7440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-922-1747
-----------------------------------------------------
Fax | 805-925-6499
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 40705
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------