MEDICARE: PRAMOD P PATEL BS

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	28RI02194300	NJ

General Provider Information

NPI Number	:	1851374953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRAMOD P PATEL BS

Provider Business Mailing Address
First Line	:	74 OLYMPIA LN
Second Line	:
City	:	SICKLERVILLE
State	:	NJ
Zip	:	08081-4013
Country	:	US
Telephone Number	:	856-262-9049
Fax Number	:	856-262-9049

Provider Business Practice Location Address
First Line	:	74 OLYMPIA LN
Second Line	:
City	:	SICKLERVILLE
State	:	NJ
Zip	:	08081-4013
Country	:	US
Telephone Number	:	856-262-9049
Fax Number	:	856-262-9049

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/08/2007

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