Provider Demographics
NPI:1063599645
Name:BHARGAV C. PATEL & RICKY B. PATEL
Entity type:Organization
Organization Name:BHARGAV C. PATEL & RICKY B. PATEL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-776-2800
Mailing Address - Street 1:1120 W LA PALMA
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801
Mailing Address - Country:US
Mailing Address - Phone:714-776-2800
Mailing Address - Fax:714-776-2118
Practice Address - Street 1:1120 W LA PALMA
Practice Address - Street 2:SUITE #1
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:714-776-2800
Practice Address - Fax:714-776-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
CAPHY554723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY57301OtherSTATE PHARMACY LICENSE
CA0511039OtherNCPDP
CAPHA573010Medicaid
CAPHA573010Medicaid
CA0289690001Medicare NSC