Healthcare Provider Details

I. General information

NPI: 1184950164
Provider Name (Legal Business Name): JASON YOGIN PATEL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-6180
US

IV. Provider business mailing address

27 N DECKER AVE
BALTIMORE MD
21224-1354
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-6505
  • Fax:
Mailing address:
  • Phone: 201-841-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18944
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03303700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: