Provider Demographics
NPI:1851374953
Name:PATEL, PRAMOD P (BS)
Entity Type:Individual
Prefix:
First Name:PRAMOD
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 OLYMPIA LN
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4013
Mailing Address - Country:US
Mailing Address - Phone:856-262-9049
Mailing Address - Fax:856-262-9049
Practice Address - Street 1:74 OLYMPIA LN
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-4013
Practice Address - Country:US
Practice Address - Phone:856-262-9049
Practice Address - Fax:856-262-9049
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02194300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist