Provider Demographics
NPI:1861064289
Name:PATEL, KIRTAN TARUN (PHARMD)
Entity type:Individual
Prefix:
First Name:KIRTAN
Middle Name:TARUN
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 W POLK AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6037
Mailing Address - Country:US
Mailing Address - Phone:714-383-4276
Mailing Address - Fax:
Practice Address - Street 1:12540 MCCANN DR
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3337
Practice Address - Country:US
Practice Address - Phone:714-383-4276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist