MEDICARE: DHAVAL PATEL

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	22331	IA

General Provider Information

NPI Number	:	1144884214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DHAVAL PATEL

Provider Business Mailing Address
First Line	:	2701 W BURLINGTON AVE
Second Line	:
City	:	FAIRFIELD
State	:	IA
Zip	:	52556-2645
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 W BURLINGTON AVE
Second Line	:
City	:	FAIRFIELD
State	:	IA
Zip	:	52556-2645
Country	:	US
Telephone Number	:	641-472-6199
Fax Number	:

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

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	04/24/2019

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Directions to “ DHAVAL PATEL ” Practice Location

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