Provider Demographics
NPI:1740457779
Name:PATEL, PIYUSH R (RPH)
Entity type:Individual
Prefix:
First Name:PIYUSH
Middle Name:R
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 1:6562 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7067
Mailing Address - Country:US
Mailing Address - Phone:347-227-8188
Mailing Address - Fax:347-227-8402
Practice Address - Street 1:6562 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7067
Practice Address - Country:US
Practice Address - Phone:347-227-8188
Practice Address - Fax:347-227-8402
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2014-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist