MEDICARE: MR. JITESH A PATEL PHARM. D

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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417976952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JITESH A PATEL PHARM. D

Provider Business Mailing Address
First Line	:	1412 PINE COVE CT
Second Line	:
City	:	DARIEN
State	:	IL
Zip	:	60561-4999
Country	:	US
Telephone Number	:	630-427-1768
Fax Number	:	708-345-1011

Provider Business Practice Location Address
First Line	:	1516 MADISON ST
Second Line	:
City	:	MAYWOOD
State	:	IL
Zip	:	60153-1824
Country	:	US
Telephone Number	:	708-345-4658
Fax Number	:	708-345-1011

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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