Provider Demographics
NPI:1598181794
Name:PATEL, KEVIN H
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:H
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 REDTAIL HAWK CIR
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9530
Mailing Address - Country:US
Mailing Address - Phone:856-298-3504
Mailing Address - Fax:
Practice Address - Street 1:117 REDTAIL HAWK CIR
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9530
Practice Address - Country:US
Practice Address - Phone:856-298-3504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03623100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03623100OtherPHARMACIST LICENSE