Healthcare Provider Details

I. General information

NPI: 1104132653
Provider Name (Legal Business Name): MAITRIBEN RUCHIR PATEL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2010
Last Update Date: 08/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N OLDEN AVE
EWING NJ
08638-3102
US

IV. Provider business mailing address

37 FENTON LN
CHESTERFIELD NJ
08515-9724
US

V. Phone/Fax

Practice location:
  • Phone: 609-896-9089
  • Fax:
Mailing address:
  • Phone: 609-372-4918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03044800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: