Provider Demographics
NPI:1447858477
Name:PATEL, HARDIK R
Entity type:Individual
Prefix:
First Name:HARDIK
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 NEWBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-8835
Mailing Address - Country:US
Mailing Address - Phone:630-363-1239
Mailing Address - Fax:
Practice Address - Street 1:222 W MCCOY BLVD
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-3291
Practice Address - Country:US
Practice Address - Phone:608-372-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.298441183500000X
WI17789-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist