Healthcare Provider Details

I. General information

NPI: 1568783751
Provider Name (Legal Business Name): VIPULKUMAR T PATEL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E BROAD ST
PAULSBORO NJ
08066-1451
US

IV. Provider business mailing address

1 E BROAD ST
PAULSBORO NJ
08066-1451
US

V. Phone/Fax

Practice location:
  • Phone: 856-224-0533
  • Fax: 856-224-1845
Mailing address:
  • Phone: 856-224-0533
  • Fax: 856-224-1845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02308400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: