Provider Demographics
NPI:1730710120
Name:PATEL, DHRUMILKUMAR D (PHARM D)
Entity type:Individual
Prefix:
First Name:DHRUMILKUMAR
Middle Name:D
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:DHRUV
Other - Middle Name:D
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1535 RIVER PARKWAY BLVD APT 907
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-1811
Mailing Address - Country:US
Mailing Address - Phone:973-216-6541
Mailing Address - Fax:
Practice Address - Street 1:1401 N TRENTON ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2325
Practice Address - Country:US
Practice Address - Phone:873-854-8731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist