Provider Demographics
NPI:1619155876
Name:PATEL, KALPANA DIPAK
Entity Type:Individual
Prefix:MRS
First Name:KALPANA
Middle Name:DIPAK
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 1:13 ANITA AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3103
Mailing Address - Country:US
Mailing Address - Phone:732-548-4236
Mailing Address - Fax:
Practice Address - Street 1:789 SAINT GEORGE AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3157
Practice Address - Country:US
Practice Address - Phone:732-855-9412
Practice Address - Fax:732-855-9421
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02369400183500000X
NY041576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY041576OtherREGISTERED PHARMACIST
NJ28RI02369400OtherREGISTERED PHARMACIST