Basic Information
| Provider Information | |||||||||
| NPI: | 1275800682 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | YATIN | ||||||||
| MiddleName: | P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11304 HAWTHORNE DR | ||||||||
| Address2: | STE 120 | ||||||||
| City: | MINT HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282279425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045736899 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11304 HAWTHORNE DR | ||||||||
| Address2: | STE 120 | ||||||||
| City: | MINT HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282279425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045736899 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2011 | ||||||||
| LastUpdateDate: | 08/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 22084 | NC | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.