Provider Demographics
NPI:1184763534
Name:PATEL, MANILAL A (RPH)
Entity type:Individual
Prefix:MR
First Name:MANILAL
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 1:144 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2568
Mailing Address - Country:US
Mailing Address - Phone:201-991-2444
Mailing Address - Fax:201-991-2447
Practice Address - Street 1:434 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2604
Practice Address - Country:US
Practice Address - Phone:201-991-2444
Practice Address - Fax:201-991-2447
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01557100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP0795516610643OtherDRIVING LICENSE
NJ28RI01557100OtherRPH