Provider Demographics
NPI:1891905394
Name:PATEL, KAMLESH VITTHAL (RPH)
Entity Type:Individual
Prefix:
First Name:KAMLESH
Middle Name:VITTHAL
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 1:17 BARD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3278
Mailing Address - Country:US
Mailing Address - Phone:732-605-9141
Mailing Address - Fax:732-229-3073
Practice Address - Street 1:67 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-1630
Practice Address - Country:US
Practice Address - Phone:732-229-4200
Practice Address - Fax:732-229-3073
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02254800OtherRPH LICENSE NUMBER