Provider Demographics
NPI:1821184631
Name:PATEL, KANAIYALAL A (RPH)
Entity Type:Individual
Prefix:
First Name:KANAIYALAL
Middle Name:A
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 1:435 TAPPAN RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-1419
Mailing Address - Country:US
Mailing Address - Phone:201-784-0239
Mailing Address - Fax:718-329-3466
Practice Address - Street 1:435 TAPPAN RD
Practice Address - Street 2:
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-1419
Practice Address - Country:US
Practice Address - Phone:201-784-0239
Practice Address - Fax:718-329-3466
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist