Provider Demographics
NPI:1578604062
Name:PATEL, MAHESH M (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MAHESH
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 THORNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6441
Mailing Address - Country:US
Mailing Address - Phone:631-586-2082
Mailing Address - Fax:
Practice Address - Street 1:9037 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1352
Practice Address - Country:US
Practice Address - Phone:718-464-4844
Practice Address - Fax:718-464-9835
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist