Provider Demographics
NPI:1073927687
Name:PATEL, JIGISHA
Entity Type:Individual
Prefix:
First Name:JIGISHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 KINGS VLG
Mailing Address - Street 2:
Mailing Address - City:MINERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17954-1902
Mailing Address - Country:US
Mailing Address - Phone:570-544-8290
Mailing Address - Fax:570-544-9274
Practice Address - Street 1:44 KINGS VLG
Practice Address - Street 2:
Practice Address - City:MINERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17954-1902
Practice Address - Country:US
Practice Address - Phone:570-544-8290
Practice Address - Fax:570-544-9274
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist