Provider Demographics
NPI:1295286193
Name:PATEL, PRAGNESH (PHARM D)
Entity type:Individual
Prefix:
First Name:PRAGNESH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
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 1:18 PLAYER AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-5064
Mailing Address - Country:US
Mailing Address - Phone:229-848-8695
Mailing Address - Fax:
Practice Address - Street 1:1501 US HWY 22
Practice Address - Street 2:WALMART PHARMACY
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069
Practice Address - Country:US
Practice Address - Phone:908-756-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03788600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist