Provider Demographics
NPI:1396052882
Name:PATEL, KOMAL H (RPH)
Entity type:Individual
Prefix:MS
First Name:KOMAL
Middle Name:H
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WISTER PL
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-1824
Mailing Address - Country:US
Mailing Address - Phone:732-765-0058
Mailing Address - Fax:
Practice Address - Street 1:5 WISTER PL
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-1824
Practice Address - Country:US
Practice Address - Phone:732-765-0058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO2544600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist