Provider Demographics
NPI:1275771172
Name:PATEL, MITAL VIPIN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MITAL
Middle Name:VIPIN
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 1:694 FOCH BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1511
Mailing Address - Country:US
Mailing Address - Phone:516-294-1065
Mailing Address - Fax:
Practice Address - Street 1:492 E 169TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-2627
Practice Address - Country:US
Practice Address - Phone:718-538-3385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist