Provider Demographics
NPI:1205473337
Name:PATEL, KOMAL CHINMAY
Entity type:Individual
Prefix:
First Name:KOMAL
Middle Name:CHINMAY
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 KENDRA LN
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-9270
Mailing Address - Country:US
Mailing Address - Phone:414-719-9893
Mailing Address - Fax:
Practice Address - Street 1:1320 KENDRA LN
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-9270
Practice Address - Country:US
Practice Address - Phone:414-719-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist