Provider Demographics
NPI:1629350731
Name:PATEL, SANJAY SHANTIBHAI (BS PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:SANJAY
Middle Name:SHANTIBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:BS PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2600 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1619
Mailing Address - Country:US
Mailing Address - Phone:510-742-9356
Mailing Address - Fax:510-742-9386
Practice Address - Street 1:37323 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-3702
Practice Address - Country:US
Practice Address - Phone:510-797-2772
Practice Address - Fax:510-797-4986
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48629183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629350731Medicaid