Healthcare Provider Details

I. General information

NPI: 1043080906
Provider Name (Legal Business Name): VIDHI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 HOWARD AVE
NEW HAVEN CT
06519-1304
US

IV. Provider business mailing address

106 ELVREE ST
MANCHESTER CT
06042-8240
US

V. Phone/Fax

Practice location:
  • Phone: 888-461-0106
  • Fax:
Mailing address:
  • Phone: 913-626-5758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-104074
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: