Provider Demographics
NPI:1023535028
Name:PATEL, DIXABAHEN MAHENDRABHAI (RPH)
Entity Type:Individual
Prefix:
First Name:DIXABAHEN
Middle Name:MAHENDRABHAI
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-2467
Mailing Address - Country:US
Mailing Address - Phone:201-208-1639
Mailing Address - Fax:
Practice Address - Street 1:706 CASTLE HILL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-1303
Practice Address - Country:US
Practice Address - Phone:718-319-8200
Practice Address - Fax:718-319-8240
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist