Individual
AVNI PATEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
379 W PONTOON RD, GRANITE CITY, IL 62040-6848
(618) 451-6002
Mailing address
379 W PONTOON RD, GRANITE CITY, IL 62040-6848
(618) 451-6002
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
051305309
IL
3336C0003X
Community/Retail Pharmacy
Primary
051305309
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051305309
STATE LICENSE
IL
Enumeration date
02/27/2023
Last updated
11/18/2024
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