Provider Demographics
NPI:1053746909
Name:PATEL, MAULIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MAULIN
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NEWPORTVILLE RD
Mailing Address - Street 2:APT 515
Mailing Address - City:CROYDON
Mailing Address - State:PA
Mailing Address - Zip Code:19021-5055
Mailing Address - Country:US
Mailing Address - Phone:609-271-6312
Mailing Address - Fax:
Practice Address - Street 1:1509 ROUTE 38
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2271
Practice Address - Country:US
Practice Address - Phone:856-663-1021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03450000183500000X
PARP447628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03450000OtherREGISTERED PHARMACIST
PARP447628OtherREGISTERED PHARMACIST