Provider Demographics
NPI:1457937831
Name:PATEL, JAIMINI
Entity Type:Individual
Prefix:
First Name:JAIMINI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 JEFFERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:WOODLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19094
Mailing Address - Country:US
Mailing Address - Phone:610-833-5600
Mailing Address - Fax:610-833-1954
Practice Address - Street 1:1301 JEFFERSON AVENUE
Practice Address - Street 2:
Practice Address - City:WOODLYN
Practice Address - State:PA
Practice Address - Zip Code:19094
Practice Address - Country:US
Practice Address - Phone:610-833-5600
Practice Address - Fax:610-833-1954
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045694R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist