Healthcare Provider Details

I. General information

NPI: 1841104064
Provider Name (Legal Business Name): TIRTH PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5623 CAROLINA BEACH RD
WILMINGTON NC
28412-2632
US

IV. Provider business mailing address

4362 WATERMARK DR APT 132
WILMINGTON NC
28412-7809
US

V. Phone/Fax

Practice location:
  • Phone: 910-746-6790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35054
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: