Provider Demographics
NPI:1689037160
Name:PATEL, GITA BEN
Entity Type:Individual
Prefix:
First Name:GITA
Middle Name:BEN
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 1:102 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:PA
Mailing Address - Zip Code:18414-9644
Mailing Address - Country:US
Mailing Address - Phone:570-563-1151
Mailing Address - Fax:570-563-0138
Practice Address - Street 1:102 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:PA
Practice Address - Zip Code:18414-9644
Practice Address - Country:US
Practice Address - Phone:570-563-1151
Practice Address - Fax:570-563-0138
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034485L183500000X
PARP1006565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist