Avni Patel

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

051305309 Issued in IL

Practice address

379 W Pontoon Rd
Granite City, IL 62040-6848

Phone

(618) 451-6002

NPI assigned

Feb 27, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walmart Inc.

  • Community/Retail Pharmacy
  • Granite City, IL
  • NPI 1407873789
  NPD (past)
• Walmart Inc.

  • Community/Retail Pharmacy
  • Eastvale, CA
  • NPI 1770458945
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1677456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1942909114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "379 W PONTOON RD",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620406848",
            "telephone_number": "618-451-6002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "379 W PONTOON RD",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620406848",
            "telephone_number": "618-451-6002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "AVNI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-27",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051305309",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "051305309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "051305309",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katrina Lyn Olden, LCPC
• Paul Joseph Pace, M.D.
• Cody James Palmer, APN
• John K Parker, M.D., M.P.H.
• Amanda Leigh Parsley, D.O.
• Kanubhai M Patel, M.D.
• Joellyn Marie Patterson, BA, CADC
• Janice M Pautler, RD,LD
• Albert Pelate, RPH
• Oscar Adrian Perez, PA-C

• Community/Retail Pharmacy in Granite City, IL
• Providers in Granite City, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.