Provider Demographics
NPI:1508284746
Name:PATEL, VIJAYKUMAR (MS)
Entity Type:Individual
Prefix:
First Name:VIJAYKUMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 DRUM POINT RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6840
Mailing Address - Country:US
Mailing Address - Phone:732-477-0600
Mailing Address - Fax:
Practice Address - Street 1:336 DRUM POINT RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6840
Practice Address - Country:US
Practice Address - Phone:732-477-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01972200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist