Provider Demographics
NPI:1447853452
Name:PATEL, SHASHVAT DUSHYANTKUMAR (PHARMD)
Entity type:Individual
Prefix:
First Name:SHASHVAT
Middle Name:DUSHYANTKUMAR
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 1:6357 BURNT MOUNTAIN PATH
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-7404
Mailing Address - Country:US
Mailing Address - Phone:443-980-0616
Mailing Address - Fax:
Practice Address - Street 1:3757 OLD COURT RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3902
Practice Address - Country:US
Practice Address - Phone:410-602-7661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD25156OtherMARYLAND BOARD OF PHARMACY LICENSE