Provider Demographics
NPI:1003092636
Name:PATEL, MANISH S (RPH)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:S
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 1:2810 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4023
Mailing Address - Country:US
Mailing Address - Phone:718-401-6778
Mailing Address - Fax:718-993-1483
Practice Address - Street 1:2810 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4023
Practice Address - Country:US
Practice Address - Phone:718-401-6778
Practice Address - Fax:718-993-1483
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049936-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist