MEDICARE: MR. MAYUR K PATEL RPH

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	051.286571	IL
2	183500000X	Pharmacist	5302031746	MI
3	183500000X	Pharmacist	013103	KY
4	183500000X	Pharmacist	RPH-0011863	OR

General Provider Information

NPI Number	:	1386911964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MAYUR K PATEL RPH

Provider Business Mailing Address
First Line	:	740 N HUNDLEY ST
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-4557
Country	:	US
Telephone Number	:	847-882-5169
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 BIERMANN CT
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-2151
Country	:	US
Telephone Number	:	847-634-7111
Fax Number	:

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

Provider Enumeration Date	:	11/25/2011
Last Update Date	:	11/25/2011

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