Provider Demographics
NPI:1023206885
Name:PATEL, SAMIR H (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMIR
Middle Name:H
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 1:40 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2204
Mailing Address - Country:US
Mailing Address - Phone:973-256-5400
Mailing Address - Fax:973-256-3780
Practice Address - Street 1:40 GORDON DR
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2204
Practice Address - Country:US
Practice Address - Phone:973-256-5400
Practice Address - Fax:973-256-3780
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02765000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist