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General NPI Number Information
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NPI Number | 1841581485
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Entity Type | Individual
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Provider Name | DIVYESHKUMAR PATEL PHARM. D
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Gender | Male
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Dates
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Enumeration Date | 05/01/2011
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Last Update Date | 05/01/2011
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Provider Practice Location Address
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Address Line | 11743 15 MILE RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-5103
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Country | US
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Telephone | 586-979-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 18157 FLEUR DE LIS
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1277
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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 |
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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 | 5302035095
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License Number State | MI
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