Provider Demographics
NPI:1750914685
Name:PATEL, GAURANG R
Entity type:Individual
Prefix:
First Name:GAURANG
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-6240
Mailing Address - Country:US
Mailing Address - Phone:302-998-2626
Mailing Address - Fax:302-998-2654
Practice Address - Street 1:1251 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-6240
Practice Address - Country:US
Practice Address - Phone:302-998-2626
Practice Address - Fax:302-998-2654
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-00005429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist