Provider Demographics
NPI:1609201177
Name:PATEL, POOJA K (PHARM D)
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:K
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 82ND ST
Mailing Address - Street 2:APT. 1I
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-2937
Mailing Address - Country:US
Mailing Address - Phone:718-507-2678
Mailing Address - Fax:
Practice Address - Street 1:6200 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1409
Practice Address - Country:US
Practice Address - Phone:718-945-2400
Practice Address - Fax:718-945-2287
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist