Provider Demographics
NPI:1255676367
Name:PATEL, PRAGNESHKUMAR R
Entity Type:Individual
Prefix:MR
First Name:PRAGNESHKUMAR
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:PRAGNESHKUMAR
Other - Middle Name:R
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1921 CAVALIER LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-3873
Mailing Address - Country:US
Mailing Address - Phone:904-673-0588
Mailing Address - Fax:610-236-0993
Practice Address - Street 1:1220 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-1458
Practice Address - Country:US
Practice Address - Phone:904-673-0588
Practice Address - Fax:610-236-0993
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443298183500000X
FLPS37383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist