Provider Demographics
NPI:1205852118
Name:PATEL, NIVEDITA H (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NIVEDITA
Middle Name:H
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 1:418 LIGHTHOUSE TRL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-3641
Mailing Address - Country:US
Mailing Address - Phone:937-885-5642
Mailing Address - Fax:937-424-5944
Practice Address - Street 1:1 ELIZABETH PL STE 150
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1445
Practice Address - Country:US
Practice Address - Phone:937-424-4599
Practice Address - Fax:937-424-5944
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-16515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5255000001Medicare NSC