Provider Demographics
NPI:1205208881
Name:JESSY PATEL LLC
Entity Type:Organization
Organization Name:JESSY PATEL LLC
Other - Org Name:WHITING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSY
Authorized Official - Middle Name:
Authorized Official - Last Name:VIKANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-849-3141
Mailing Address - Street 1:200 LACEY RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-1333
Mailing Address - Country:US
Mailing Address - Phone:732-849-3141
Mailing Address - Fax:
Practice Address - Street 1:200 LACEY RD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-1333
Practice Address - Country:US
Practice Address - Phone:732-849-3141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007450003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
7491800001Medicare NSC