Provider Demographics
NPI:1871808576
Name:PATEL, MANOJ B (RPH)
Entity type:Individual
Prefix:
First Name:MANOJ
Middle Name:B
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 1:5322 PEMBURY DR
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1534
Mailing Address - Country:US
Mailing Address - Phone:714-523-4075
Mailing Address - Fax:
Practice Address - Street 1:16900 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5904
Practice Address - Country:US
Practice Address - Phone:562-925-6505
Practice Address - Fax:562-925-8786
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist