Healthcare Provider Details

I. General information

NPI: 1154765642
Provider Name (Legal Business Name): PURVI PATEL PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 NEW JERSEY ROUTE 73
EVESHAM TOWNSHIP NJ
08053
US

IV. Provider business mailing address

32 BROWNSTONE BLVD
VOORHEES NJ
08043-3451
US

V. Phone/Fax

Practice location:
  • Phone: 856-988-6164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03538800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: