Healthcare Provider Details

I. General information

NPI: 1770933624
Provider Name (Legal Business Name): HETAL PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 FARMINGTON AVE STE 108
FARMINGTON CT
06032-1965
US

IV. Provider business mailing address

270 FARMINGTON AVE STE 108
FARMINGTON CT
06032-1965
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-6772
  • Fax: 860-679-0303
Mailing address:
  • Phone: 860-679-6772
  • Fax: 860-679-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10162
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: