Provider Demographics
NPI:1003580432
Name:PATEL, JUSTEENA (PHARM D)
Entity type:Individual
Prefix:
First Name:JUSTEENA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GRAFTON ST APT 501
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4947
Mailing Address - Country:US
Mailing Address - Phone:415-948-1499
Mailing Address - Fax:
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-1712
Practice Address - Country:US
Practice Address - Phone:508-943-4375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH240218OtherMASSACHUSETTS BOARD OF PHARMACY