Provider Demographics
NPI:1700235421
Name:PATEL, MAULIKA
Entity Type:Individual
Prefix:
First Name:MAULIKA
Middle Name:
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 1:101 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-4154
Mailing Address - Country:US
Mailing Address - Phone:856-627-6649
Mailing Address - Fax:856-627-7616
Practice Address - Street 1:101 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-4154
Practice Address - Country:US
Practice Address - Phone:856-627-6649
Practice Address - Fax:856-627-7616
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02813700183500000X
NJ28RJ05400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist