Provider Demographics
NPI:1144376849
Name:PATEL, ANITA B (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 N MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1732
Mailing Address - Country:US
Mailing Address - Phone:909-985-0914
Mailing Address - Fax:909-985-0893
Practice Address - Street 1:1607 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-1732
Practice Address - Country:US
Practice Address - Phone:909-985-0914
Practice Address - Fax:909-985-0893
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH36851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH36851OtherSTATE LIC.