Provider Demographics
NPI:1033217658
Name:PATEL, SANJAY R (BS PHARM)
Entity Type:Individual
Prefix:MR
First Name:SANJAY
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 TIVED LN E
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3076
Mailing Address - Country:US
Mailing Address - Phone:732-548-9687
Mailing Address - Fax:
Practice Address - Street 1:755 EAST 149TH ST B
Practice Address - Street 2:NAYOSHA PHARMACY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455
Practice Address - Country:US
Practice Address - Phone:718-742-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist