Provider Demographics
NPI:1366050627
Name:PATEL, BHARGAVKUMAR (RPH)
Entity type:Individual
Prefix:
First Name:BHARGAVKUMAR
Middle Name:
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 1:4 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VILLA GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:61956-1517
Mailing Address - Country:US
Mailing Address - Phone:217-418-9581
Mailing Address - Fax:217-681-1043
Practice Address - Street 1:4 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VILLA GROVE
Practice Address - State:IL
Practice Address - Zip Code:61956-1517
Practice Address - Country:US
Practice Address - Phone:217-418-9581
Practice Address - Fax:217-681-1043
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051294770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist