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General NPI Number Information
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NPI Number | 1740785807
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Entity Type | Individual
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Provider Name | HETALKUMAR PATEL PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 5TH AVENUE AND ROOSEVELT ROAD BLDG 37 NW
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City | HINES
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State | IL
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Zip | 60141
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Country | US
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Telephone | 770-554-3545
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Fax | 708-786-4490
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Provider Business Mailing Address
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Address Line | 4112 VICTORIA AVE
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City | MOUNT VERNON
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State | IL
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Zip | 62864-7022
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Country | US
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Telephone | 917-698-4933
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051294793
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License Number State | IL
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