Healthcare Provider Details

I. General information

NPI: 1568619625
Provider Name (Legal Business Name): DHIREN K PATEL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE # 119 FLOOR 10D
BOSTON MA
02130-4817
US

IV. Provider business mailing address

150 S HUNTINGTON AVE # 119 FLOOR 10D
BOSTON MA
02130-4817
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-4310
  • Fax: 857-364-4506
Mailing address:
  • Phone: 857-364-4310
  • Fax: 857-364-4506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27564
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number27564
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: