Provider Demographics
NPI:1568714582
Name:PATEL, SUJATA B (RPH)
Entity Type:Individual
Prefix:
First Name:SUJATA
Middle Name:B
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 1:3300 GREENWICH RD UNIT 14
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-5781
Mailing Address - Country:US
Mailing Address - Phone:330-825-7676
Mailing Address - Fax:
Practice Address - Street 1:3300 GREENWICH RD UNIT 14
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-5781
Practice Address - Country:US
Practice Address - Phone:330-825-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03320051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist