Provider Demographics
NPI:1326198458
Name:PATEL, MUKESH S (RPH)
Entity Type:Individual
Prefix:MR
First Name:MUKESH
Middle Name:S
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 1:8241 COUNTRY POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-3003
Mailing Address - Country:US
Mailing Address - Phone:347-229-7887
Mailing Address - Fax:
Practice Address - Street 1:8241 COUNTRY POINTE CIR
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-3003
Practice Address - Country:US
Practice Address - Phone:347-229-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY048348OtherPHARMACIST LICENSE NUMBER
GARPH020698OtherPHARMACIST LICENSE NUMBER