Provider Demographics
NPI:1639342157
Name:PATEL, AJAY M (RPH)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:M
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 1:78 LAUREL HILL DR
Mailing Address - Street 2:
Mailing Address - City:WESTTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10998-3922
Mailing Address - Country:US
Mailing Address - Phone:845-258-8083
Mailing Address - Fax:
Practice Address - Street 1:78 LAUREL HILL DR
Practice Address - Street 2:
Practice Address - City:WESTTOWN
Practice Address - State:NY
Practice Address - Zip Code:10998-3922
Practice Address - Country:US
Practice Address - Phone:845-258-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY038471OtherPHARMACIST LICENSE