Provider Demographics
NPI:1184766701
Name:PATEL, AMBALAL K (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:AMBALAL
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SAMPSON ST
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1313
Mailing Address - Country:US
Mailing Address - Phone:631-567-3070
Mailing Address - Fax:631-968-9049
Practice Address - Street 1:350 E MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3100
Practice Address - Country:US
Practice Address - Phone:631-475-6666
Practice Address - Fax:631-768-9049
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY031894OtherNYSTATE RPH LIC.NO