Healthcare Provider Details

I. General information

NPI: 1376462143
Provider Name (Legal Business Name): JILL D PATEL PHARMACY STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 ELM ST
MANCHESTER NH
03101-1305
US

IV. Provider business mailing address

36 BREWSTER ST
NORTH ANDOVER MA
01845-5008
US

V. Phone/Fax

Practice location:
  • Phone: 978-971-8290
  • Fax:
Mailing address:
  • Phone: 978-971-8290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberINT10347
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: