Provider Demographics
NPI:1114245651
Name:PATEL, SMITA V (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SMITA
Middle Name:V
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 1:480 CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3808
Mailing Address - Country:US
Mailing Address - Phone:856-782-5125
Mailing Address - Fax:
Practice Address - Street 1:480 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3808
Practice Address - Country:US
Practice Address - Phone:856-782-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01569600183500000X
DEA1-0003358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist