Provider Demographics
NPI:1437747904
Name:PATEL, MAYAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MAYAN
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 HARLAN BLVD UNIT 514
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-5172
Mailing Address - Country:US
Mailing Address - Phone:334-419-6178
Mailing Address - Fax:
Practice Address - Street 1:2500 W 4TH ST STE 1
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3352
Practice Address - Country:US
Practice Address - Phone:302-660-8847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0005455183500000X
MD27148183500000X
AL20451183500000X
PARP454312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist