Provider Demographics
NPI:1770730525
Name:PATEL, PRITI P (RPH)
Entity type:Individual
Prefix:MRS
First Name:PRITI
Middle Name:P
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 METROPOLITAN AVE
Mailing Address - Street 2:C/O LEROY PHARMACY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7402
Mailing Address - Country:US
Mailing Address - Phone:718-823-4344
Mailing Address - Fax:718-823-0750
Practice Address - Street 1:1448 METROPOLITAN AVE
Practice Address - Street 2:C/O LEROY PHARMACY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7402
Practice Address - Country:US
Practice Address - Phone:718-823-4344
Practice Address - Fax:718-823-0750
Is Sole Proprietor?:No
Enumeration Date:2008-08-23
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01874657Medicaid
NY01958658Medicaid
NY1180120001Medicare NSC