Provider Demographics
NPI:1740562453
Name:PATEL, MAITRI (PHARM D)
Entity Type:Individual
Prefix:
First Name:MAITRI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BEELZEBUB RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2279
Mailing Address - Country:US
Mailing Address - Phone:860-648-9830
Mailing Address - Fax:
Practice Address - Street 1:1 ELM ST
Practice Address - Street 2:
Practice Address - City:WINDSOR LOCKS
Practice Address - State:CT
Practice Address - Zip Code:06096-2334
Practice Address - Country:US
Practice Address - Phone:860-292-1751
Practice Address - Fax:860-292-8860
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0010829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist