Provider Demographics
NPI:1053620641
Name:DR PATEL PHARMACY
Entity type:Organization
Organization Name:DR PATEL PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MAHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:610-350-6091
Mailing Address - Street 1:6 THISTLE LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2228 W 9TH ST
Practice Address - Street 2:
Practice Address - City:CHESTER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:19013-2402
Practice Address - Country:US
Practice Address - Phone:484-483-9632
Practice Address - Fax:484-483-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4820713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3994476OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PA1025179830001Medicaid