Provider Demographics
NPI:1225752363
Name:PATEL, DHARA RAKESHKUMAR
Entity Type:Individual
Prefix:
First Name:DHARA RAKESHKUMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DHARA
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6608 GRAND CENTRAL PKWY APT 1A
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1981
Mailing Address - Country:US
Mailing Address - Phone:917-651-4404
Mailing Address - Fax:
Practice Address - Street 1:6608 GRAND CENTRAL PKWY APT 1A
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1981
Practice Address - Country:US
Practice Address - Phone:917-651-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist