Provider Demographics
NPI:1376623108
Name:PATEL, RAHULKUMAR M (RPH)
Entity Type:Individual
Prefix:
First Name:RAHULKUMAR
Middle Name:M
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 1:118 HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924
Mailing Address - Country:US
Mailing Address - Phone:845-888-2614
Mailing Address - Fax:
Practice Address - Street 1:2930 ROUTE 209
Practice Address - Street 2:
Practice Address - City:WURTSBORO
Practice Address - State:NY
Practice Address - Zip Code:12790
Practice Address - Country:US
Practice Address - Phone:845-888-2614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY35669OtherNY STATE PHARMACY LICENSE