MEDICARE: MINESH CHANDRAKANT PATEL R.PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	031167	NJ
2	183500000X	Pharmacist	052327	NY

General Provider Information

NPI Number	:	1710135447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINESH CHANDRAKANT PATEL R.PH

Provider Business Mailing Address
First Line	:	19 S LEXOW AVE
Second Line	:
City	:	NANUET
State	:	NY
Zip	:	10954-3234
Country	:	US
Telephone Number	:	845-398-8163
Fax Number	:

Provider Business Practice Location Address
First Line	:	5105 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3511
Country	:	US
Telephone Number	:	718-240-9924
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2008
Last Update Date	:	09/06/2008

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