Provider Demographics
NPI:1568783751
Name:PATEL, VIPULKUMAR T (RPH)
Entity Type:Individual
Prefix:MR
First Name:VIPULKUMAR
Middle Name:T
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 1:1 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PAULSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08066-1451
Mailing Address - Country:US
Mailing Address - Phone:856-224-0533
Mailing Address - Fax:856-224-1845
Practice Address - Street 1:1 E BROAD ST
Practice Address - Street 2:
Practice Address - City:PAULSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08066-1451
Practice Address - Country:US
Practice Address - Phone:856-224-0533
Practice Address - Fax:856-224-1845
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02308400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist