Provider Demographics
NPI:1598034704
Name:PATEL, DIMPAL
Entity Type:Individual
Prefix:
First Name:DIMPAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103
Mailing Address - Country:US
Mailing Address - Phone:847-736-3960
Mailing Address - Fax:856-479-9566
Practice Address - Street 1:7201 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1107
Practice Address - Country:US
Practice Address - Phone:215-554-6750
Practice Address - Fax:215-554-6756
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-292504183500000X
PARP444148183500000X
NJ28RI03790400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist