Provider Demographics
NPI:1710135447
Name:PATEL, MINESH CHANDRAKANT (RPH)
Entity Type:Individual
Prefix:
First Name:MINESH
Middle Name:CHANDRAKANT
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 1:19 S LEXOW AVE
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-3234
Mailing Address - Country:US
Mailing Address - Phone:845-398-8163
Mailing Address - Fax:
Practice Address - Street 1:5105 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3511
Practice Address - Country:US
Practice Address - Phone:718-240-9924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ031167183500000X
NY052327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist