Provider Demographics
NPI:1144599291
Name:PATEL, ANTIM R
Entity Type:Individual
Prefix:
First Name:ANTIM
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 SOUTH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1528
Mailing Address - Country:US
Mailing Address - Phone:215-735-1200
Mailing Address - Fax:215-735-0455
Practice Address - Street 1:1735 SOUTH ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1528
Practice Address - Country:US
Practice Address - Phone:215-735-1200
Practice Address - Fax:215-735-0455
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist