Provider Demographics
NPI:1629364781
Name:PATEL, MANISH R (PHARM D)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
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 1:35 COMPUTER DR
Mailing Address - Street 2:T-2325
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-1236
Mailing Address - Country:US
Mailing Address - Phone:978-377-9004
Mailing Address - Fax:978-377-9004
Practice Address - Street 1:35 COMPUTER DR
Practice Address - Street 2:T-2325
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-1236
Practice Address - Country:US
Practice Address - Phone:978-377-9004
Practice Address - Fax:978-377-9004
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist