Provider Demographics
NPI:1356752125
Name:PATEL, MILANKUMAR ARVINDBHAI
Entity type:Individual
Prefix:
First Name:MILANKUMAR
Middle Name:ARVINDBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 LIBERTY ST
Mailing Address - Street 2:APT 71
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1388
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 LIBERTY ST
Practice Address - Street 2:APT 71
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643-1388
Practice Address - Country:US
Practice Address - Phone:201-920-6214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2020-05-12
Deactivation Date:2020-05-01
Deactivation Code:
Reactivation Date:2020-05-12
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03629500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist