Provider Demographics
NPI:1912492307
Name:JESSY PATEL 2 LLC
Entity Type:Organization
Organization Name:JESSY PATEL 2 LLC
Other - Org Name:BAYVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSY
Authorized Official - Middle Name:
Authorized Official - Last Name:VIKANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-797-9955
Mailing Address - Street 1:495 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1850
Mailing Address - Country:US
Mailing Address - Phone:732-797-9955
Mailing Address - Fax:732-797-9956
Practice Address - Street 1:495 ROUTE 9
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1850
Practice Address - Country:US
Practice Address - Phone:732-797-9955
Practice Address - Fax:732-797-9956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007652003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy