Provider Demographics
NPI:1376827154
Name:PATEL, MITUL P (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:MITUL
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TED LIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854
Mailing Address - Country:US
Mailing Address - Phone:848-228-9655
Mailing Address - Fax:908-680-6937
Practice Address - Street 1:45 S MARTINE AVE
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1216
Practice Address - Country:US
Practice Address - Phone:908-680-6936
Practice Address - Fax:908-680-6937
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03283400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist