Provider Demographics
NPI:1235293960
Name:PATEL, VIPUL H (RPH)
Entity Type:Individual
Prefix:
First Name:VIPUL
Middle Name:H
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 1:9 LILY ROAD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:732-548-9339
Mailing Address - Fax:
Practice Address - Street 1:338 PALISADE AVE
Practice Address - Street 2:PALISADE DRUGS
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-1753
Practice Address - Country:US
Practice Address - Phone:201-222-9399
Practice Address - Fax:201-222-0255
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02610900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist