Provider Demographics
NPI:1730286154
Name:PATEL, PANKAJ R (BS PHARM)
Entity Type:Individual
Prefix:MR
First Name:PANKAJ
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-7505
Mailing Address - Country:US
Mailing Address - Phone:732-764-8979
Mailing Address - Fax:
Practice Address - Street 1:54 E 183RD ST
Practice Address - Street 2:PRAYOSHA PHARMACY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453
Practice Address - Country:US
Practice Address - Phone:718-220-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist