Provider Demographics
NPI:1851609986
Name:PATEL, JAYDEEP K
Entity Type:Individual
Prefix:
First Name:JAYDEEP
Middle Name:K
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 1:141 MARGINAL STREET
Mailing Address - Street 2:P.O BOX 760
Mailing Address - City:COOLEEMEE
Mailing Address - State:NC
Mailing Address - Zip Code:27014
Mailing Address - Country:US
Mailing Address - Phone:336-284-2537
Mailing Address - Fax:336-284-2538
Practice Address - Street 1:141 MARGINAL STREET
Practice Address - Street 2:
Practice Address - City:COOLEEMEE
Practice Address - State:NC
Practice Address - Zip Code:27014
Practice Address - Country:US
Practice Address - Phone:336-284-2537
Practice Address - Fax:336-284-2538
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03222000183500000X
NY054387183500000X
NC23981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist