Provider Demographics
NPI:1194030197
Name:PATEL, GIRISHKUMAR P (RPH)
Entity Type:Individual
Prefix:
First Name:GIRISHKUMAR
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELIZABETH AVE
Mailing Address - Street 2:BERT'S PHARMACY
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07206-1146
Mailing Address - Country:US
Mailing Address - Phone:908-351-0644
Mailing Address - Fax:908-351-0759
Practice Address - Street 1:601 ELIZABETH AVE
Practice Address - Street 2:BERT'S PHARMACY
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07206
Practice Address - Country:US
Practice Address - Phone:908-351-0644
Practice Address - Fax:908-351-0759
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02960900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02960900OtherSTATE LICENSE