Provider Demographics
NPI:1245483585
Name:PATEL, JITENDRA K (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JITENDRA
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 1:40 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2203
Mailing Address - Country:US
Mailing Address - Phone:908-725-0585
Mailing Address - Fax:
Practice Address - Street 1:1380 LORING AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208
Practice Address - Country:US
Practice Address - Phone:718-277-0898
Practice Address - Fax:718-277-0895
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000120183500000X
NJ28RI02906300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist