Provider Demographics
NPI:1619396520
Name:PATEL, SHAILA (RPH)
Entity Type:Individual
Prefix:
First Name:SHAILA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 MILL RUN
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1754
Mailing Address - Country:US
Mailing Address - Phone:718-863-0210
Mailing Address - Fax:718-863-0707
Practice Address - Street 1:611 MILL RUN
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1754
Practice Address - Country:US
Practice Address - Phone:718-863-0210
Practice Address - Fax:718-863-0707
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY041716OtherPHARMACIST