MEDICARE: MRS. ANITA B PATEL R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH36851	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RPH36851	OTHER	CA	STATE LIC.

General Provider Information

NPI Number	:	1144376849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANITA B PATEL R.PH.

Provider Business Mailing Address
First Line	:	1607 N MOUNTAIN AVE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91784-1732
Country	:	US
Telephone Number	:	909-985-0914
Fax Number	:	909-985-0893

Provider Business Practice Location Address
First Line	:	1607 N MOUNTAIN AVE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91784-1732
Country	:	US
Telephone Number	:	909-985-0914
Fax Number	:	909-985-0893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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