Provider Demographics
NPI:1053500421
Name:PATEL, RACHANA K (RPH)
Entity Type:Individual
Prefix:
First Name:RACHANA
Middle Name:K
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 1:161 CENTEREACH MALL
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2750
Mailing Address - Country:US
Mailing Address - Phone:631-467-5347
Mailing Address - Fax:631-467-5628
Practice Address - Street 1:161 CENTEREACH MALL
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2750
Practice Address - Country:US
Practice Address - Phone:631-467-5347
Practice Address - Fax:631-467-5628
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050272183500000X
NJ28RI02883300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist