Healthcare Provider Details

I. General information

NPI: 1346654753
Provider Name (Legal Business Name): KHUSHBU PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 S DUPONT HWY
DOVER DE
19901-4900
US

IV. Provider business mailing address

324 MCFARLAND DR
NEWARK DE
19702-3681
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-4788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0004507
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: