Provider Demographics
NPI:1669063301
Name:PATEL, KETANKUMAR B (RPH)
Entity type:Individual
Prefix:
First Name:KETANKUMAR
Middle Name:B
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-4086
Mailing Address - Country:US
Mailing Address - Phone:201-616-9592
Mailing Address - Fax:
Practice Address - Street 1:673 BRANCH DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4086
Practice Address - Country:US
Practice Address - Phone:201-616-9592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03401800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03401800OtherPHARMACIST LISCENSE