Provider Demographics
NPI:1790182830
Name:PATEL, PRIYANKKUMAR
Entity Type:Individual
Prefix:
First Name:PRIYANKKUMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28511 DUPONT BLVD
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-4787
Mailing Address - Country:US
Mailing Address - Phone:302-934-8175
Mailing Address - Fax:302-934-6842
Practice Address - Street 1:28511 DUPONT BLVD
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-4787
Practice Address - Country:US
Practice Address - Phone:302-934-8175
Practice Address - Fax:302-934-6842
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0004675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE183500000XOtherPHARMACISTS