Provider Demographics
NPI:1023473337
Name:PATEL, MAHESH KANTILAL (RPH)
Entity type:Individual
Prefix:MR
First Name:MAHESH
Middle Name:KANTILAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39800 FORD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4312
Mailing Address - Country:US
Mailing Address - Phone:734-981-5104
Mailing Address - Fax:734-981-5173
Practice Address - Street 1:39800 FORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4312
Practice Address - Country:US
Practice Address - Phone:734-981-5104
Practice Address - Fax:734-981-5173
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist