Healthcare Provider Details

I. General information

NPI: 1104429794
Provider Name (Legal Business Name): KINJAL PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 BRANDYWINE PKWY
WILMINGTON DE
19803-1492
US

IV. Provider business mailing address

3575 SILVERSIDE RD APT 201
WILMINGTON DE
19810-4942
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30647
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP453738
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03959300
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA10005479
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: