Provider Demographics
NPI:1710158977
Name:PATEL, BHARATKUMAR AMBALAL (PHD,RPH)
Entity Type:Individual
Prefix:DR
First Name:BHARATKUMAR
Middle Name:AMBALAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 JERUSALEM AVE
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801
Mailing Address - Country:US
Mailing Address - Phone:516-937-7500
Mailing Address - Fax:
Practice Address - Street 1:430 JERUSALEM AVE
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801
Practice Address - Country:US
Practice Address - Phone:516-937-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist