Provider Demographics
NPI:1083088223
Name:PATEL, KINNARI SAMIR
Entity Type:Individual
Prefix:MRS
First Name:KINNARI
Middle Name:SAMIR
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 1:100 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1624
Mailing Address - Country:US
Mailing Address - Phone:856-784-2999
Mailing Address - Fax:
Practice Address - Street 1:100 WARWICK RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1624
Practice Address - Country:US
Practice Address - Phone:856-784-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-28
Last Update Date:2015-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03331500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03331500OtherNJ PHARMACIST LICENSE