=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417323056
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRITESH PATEL PHARM D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2015
-----------------------------------------------------
Last Update Date | 08/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 MESQUITE DRIVE
-----------------------------------------------------
City | SELLS
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85634-0548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-383-7350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3670 WEST ARRPWWOOD PLACE
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85741-5405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-260-3751
-----------------------------------------------------
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 | S021483
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------