Provider Demographics
NPI:1043624273
Name:PATEL, JTIAN (PHARM D, MBA)
Entity Type:Individual
Prefix:
First Name:JTIAN
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARM D, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 WINTON AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2479
Mailing Address - Country:US
Mailing Address - Phone:678-471-6702
Mailing Address - Fax:
Practice Address - Street 1:8124 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1412
Practice Address - Country:US
Practice Address - Phone:410-987-5244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist