Healthcare Provider Details

I. General information

NPI: 1972072601
Provider Name (Legal Business Name): JAYESH N PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEIS PHARMACY 26075 S. RIDGE RD
DAMASCUS MD
20872
US

IV. Provider business mailing address

22563 WINDING WOODS WAY
CLARKSBURG MD
20871-3340
US

V. Phone/Fax

Practice location:
  • Phone: 301-253-9418
  • Fax: 301-482-1179
Mailing address:
  • Phone: 240-644-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12282
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: