Provider Demographics
NPI:1619291143
Name:PATEL, JITENDRA R (RPH)
Entity Type:Individual
Prefix:MR
First Name:JITENDRA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8132 265TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1535
Mailing Address - Country:US
Mailing Address - Phone:347-626-7373
Mailing Address - Fax:718-638-9007
Practice Address - Street 1:8132 265TH ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1535
Practice Address - Country:US
Practice Address - Phone:347-626-7373
Practice Address - Fax:718-638-9007
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist