Provider Demographics
NPI:1407900657
Name:PATEL, PARESH M (PHARMACITS)
Entity Type:Individual
Prefix:MR
First Name:PARESH
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMACITS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 KENNEDY BLVD E
Mailing Address - Street 2:LOWER MALL LEVEL
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4818
Mailing Address - Country:US
Mailing Address - Phone:201-453-0555
Mailing Address - Fax:201-453-0550
Practice Address - Street 1:7000 KENNEDY BLVD E
Practice Address - Street 2:LOWER MALL LEVEL
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-4818
Practice Address - Country:US
Practice Address - Phone:201-453-0555
Practice Address - Fax:201-453-0550
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00523900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6792502Medicaid